Nutrition Flashcards
1
Q
Major digestive juices in the stomach
A
Hydrochloric acid and pepsin
2
Q
Major site of absorption
A
Small intestine
3
Q
Major site of water absorption
A
large intestine
4
Q
Amount of energy yielded from Carbs and Protein:
A
4 kcal/g
5
Q
amount of energy yielded for fats
A
9 kcal/g
6
Q
Gluconeogenesis
A
the formation of glucose from non CHO sources, takes place in the liver
7
Q
Protein deficiency with inadequate calorie intake
A
Marasmus
8
Q
Protein malnutrition with plenty of carbohydrate
A
Kwashiorkor
9
Q
Amount of protein required for adults:
A
20-35% of calories.
10
Q
Amount of carbohydrate required for adults:
A
45-65% of total calories
11
Q
FIber in the diet helps to:
A
improve laxation, reduces risk of CAD, assists in maintaining normal blood glucose levels
12
Q
which type of fiber can have caloric value?
A
soluble Fiber. some energy produced when broken down and absorbed by the body. approx 2 kcal.g
13
Q
what does insoluble fiber do?
A
acts as a stool softener
14
Q
Vitamin B1
A
Thiamin
15
Q
Condition caused by Thiamin deficiency?
A
Beriberi
16
Q
Korsakoff syndrome
A
memory loss and neurologic symptoms associated with deficiency of Thiamin
17
Q
Vitamin B2
A
Riboflavin
18
Q
Riboflavin is a co-factor for FAD, which is used in:
A
TCA cycle and fatty Beta-oxidation
19
Q
Vitamin B3
A
Niacin
20
Q
Niacin is a co-factor for NAD, which is used in:
A
TCA cycle and fatty beta-oxidation
21
Q
Severe symptom of Niacin deficiency?
A
Pellagra with the 3 D’s: Diarrhea, Dementia, Dermatitis and sometimes Death
22
Q
Symptom of Niacin toxicity?
A
Flushing, gastric irritation, gout exacerbation
23
Q
Vitamin B6
A
Pyroxidine
24
Q
Vitamin B12
A
Cyanocobalamin
25
Vitamin B9
Folate
26
Vitamin B5
Pantothenic acid
27
Vitamin B7
Biotin
28
Ascorbic Acid
Vitamin C
29
Deficiency of vitamin C?
Scurvy
30
Retinol
Vitamin A
31
Leading cause of childhood blindness and night blindness?
Vitamin A deficiency
32
Which vitamin is the most toxic of all vitamins?
vitamin A
33
What does Vitamin D do?
regulates blood calcium levels, bone health, immune function, inflammation
34
D deficiency in kids?
Rickets - impaired mineralization of growing bones
35
D deficiency in adults?
Osteomalacia - poorly mineralized skeleton
36
How many minutes of sun is required for adequate D synthesis?
15+ minutes daily
37
Major function of vitamin E?
Antioxidant - protects cell membranes
38
Which lab test checks vitamin E levels?
serum alpha-tocopherol
39
Major function of Vitamin K?
activates part of the clotting cascade
40
Signs of calcium deficiency?
Rickets in kids, osteomalacia in adults. which may contribute to osteoporosis, muscle spasms, ventricular arrhythmia
41
Which mineral is strongly intertwined with Calcium and D?
Phosphorus (so can see rickets too)
42
Main function of potassium?
transmits nerve impulses (esp cardiac)
43
Signs of K deficiency
muscular weakness, paralysis, mental confusion, cardiac arrhythmia
44
Diagnostic workup for all electrolytes:
serum electrolyte, urine electrolyte, and urine osmolarity
45
Normal range for LDLs?
less than 130
46
Normal range for HDLs?
Greater than 60
47
Normal value for TC?
less than 200
48
Normal value for Lipoprotein A?
less than 30
49
Normal range for TG?
Less than 165
50
What is the function of chylomicrons?
Formed in the intestines and they transport lipids to the liver and are metabolized there
51
Cholesterol plays a role in?
membranes, steroid hormones and bile acids
52
What is used for energy by muscles?
triglycerides
53
What does the NCEP recommend for prevention screening in adults?
A fasting lipid profile every 5 years for adults age 20 and over
54
If a patient has a hx of CAD or metabolic syndrome, what is their goal LDL value?
less than 70
55
If a patient is at high risk with risk factors and family history, what is their goal LDL value?
Less than 100
56
Someone with FH, you would expect to see what values of LDL?
Homozygous - greater than 500, Heterozygous 250-500
57
Familial hyperChylomicronemia has abnormal...
lipoprotein lipase (allows VLDL back to chylomicrons)
58
If someone has high TG, what is the first step in treatment?
1. Administer a fibrate, 2. Omega-3's, then statin.
59
Which medication is the best HDL increasing med?
Niacin
60
A side effect of hypertriglyceridemia?
Recurrent pancreatitis and hepatosplenomegaly
61
What are secondary causes of high TG?
Diabetes and alcohol abuse
62
True or false, most patients with high cholesterol levels have no specific symptoms or signs?
True. Most are detected by the laboratory
63
Extremely high levels of TG (above 1000), results in formation of:
eruptive xanthomas (especially on the buttocks)
64
High levels of LDL result in:
tendinous xanthomas on certain tendons (achilles, patella, back of hand)
65
A risk factor is subtracted if:
The HDL level is greater than 60
66
Patients with 2 or more risk factors are further stratified by evaluating their 10 year risk of developing CHD using
Framingham projections of 10-year risk
67
Besides LDL control, what are other parts of the program to reduce the risk of CVD?
smoking cessation, hypertension control, and aspirin. Exercise and weight loss may reduce the LDL cholesterol and increase the HDL. Modest alcohol use (1-2oz) a day also raises HDL levels and appears to have a salutary effect on CHD rates.
68
After how much time should the effectiveness of diet therapy be assessed?
4 weeks
69
Diets very low in total fat or saturated fat may low HDL cholesterol as much as LDL, true or false?
True
70
A cholesterol lowering diet recommends how much total fat?
25-30% of total calories and saturated fat to <7%
71
What other dietary changes may also results in beneficial changes in blood lipids?
soluble fiber, garlic, soy protein, vitamin C, pecans, and plant sterols, rich in antioxidants.
72
Once the goal level is achieved, the lipid profile should be monitored periodically how often?
Every 6-12 months
73
What are the primary and secondary results of Niacin?
1st will decrease VLDL, secondary effects include decrease LDL and increase HDL, and decrease Lp(A)
74
What can help decrease the flushing and itching side effects of niacin/
Aspirin
75
How do BSA(resins) work?
by binding bile acids in the intestine (and poop out), which causes the liver to increases its production of bile acids, using hepatic cholesterol to do so. So then increases LDL uptake and decreases serum LDL levels
76
Why shouldn't you treat a patient with elevated TGS with a BSA?
Because BSA can also minimally increase TGs
77
What also should you be concerned about when administering a BSA?
GI side effects, decreased absorption of fat-soluble vitamins (warfarin interactions with vitamin K)
78
What do HMG-COA reductase inhibitors (statins) target?
they inhibit the enzyme involved with cholesterol synthesis in the liver which causes a compensatory increase in hepatic LDL receptors and a reduction in the circulating LDL levels. Modest increase in HDL.
79
More serious and uncommon side effects of statins?
liver failure and rhabdomyolysis. Liver disease is more common in patients also on fibrates or niacin
80
How does fibrates work?
Increase lipoprotein lipase
81
When to not administer fibrates?
Patient's with pre-existing gall bladder disease or with renal or hepatic insufficiency
82
Goal of omega-3?
to decrease TG levels
83
Is the regular hospital diet the same as the diet you would eat at home?
No, it is more healthy. Has no junk, lower fat, lower in sodium and higher in fiber and lean protein.
84
Main points of the soft diet?
soft tender foods that are not necessarily pureed. used as a bridge to the regular diet. Excludes chewy, crunchy, or sticky. Indicated with poor dentition, or difficulty swallowing
85
Mechanically altered/dental soft diet:
regular food all mushed up, like when you can't chew but you can swallow (Missing teeth)
86
What kind of diet would be indicated in a patient that has not had anything by mouth for a long time?
Full liquid diet, includes dairys and soups
87
What is the standard post op meal?
Clear liquid diet with no pulp, no citrus, not a lot of substance. Does include jello and clear juices. No dairy!
88
What are the indications for a low sodium diet?
HTN, heart problems, edema, liver disease, can see with a fluid restriction as well.
89
AKA the cardiac diet?
Low cholesterol diet. for patients with high LDL, and CVD
90
If a patient has constipation, chrons, or diverticulitis, give what diet?
low fiber diet with hydration
91
Indications for a high calorie diet?
malnourished, burn victim, breast feeding, cancer or with hypermetabolism (COPD, ALS, burns, etc)
92
What is the ADA diet?
consistent carbs, with no concentrated sweets
93
Indications for renal diet?
Kidney disease, dialysis. Includes low Na, Low phosphorus, low potassium,
94
When would a patient need enteral nutritional support (aka tube feeding)?
This nutrition would be necessary in patients with facial, oral, or esophageal trauma, severe dysphagia, comatose, hyperemesis, impaired digestion or absorption.
95
Tube enterostomy
stoma or semipermanent surgically placed tube directly into the small intestine (bypasses GI)
96
Parenteral nutritional support
feeding intravenously, bypassing digestion and absorption. TPN (total)
97
When would you use central vein PN?
when planned to be placed for longer than a week. (chemotherapy, etc). Safer and reduce risk of blowing out a vein
98
when would you use peripheral vein PN?
For treatment that is less than 2 weeks.
99
Blood clots are a higher risk in which form of PN?
Peripheral, but definitely a risk in central too.
100
Where does food eaten too quickly dump in "dumping syndrome"?
small intestine. Seen commonly in gastric bypass surgeries.
101
Why is it Important to avoid re-feeding syndrome?
To avoid electrolytes getting wonky, so monitor labs and start low and go slow.
102
Name two common adverse reactions of a supplement or food that can interact with a rx med:
Grapefruit juice and statins, and garlic with blood thinners
103
Major causes of Vitamin D deficiency and insufficiency?
Decreased renal hydroxylation of vitamin D, poor nutrition, scarce exposition to sunlight, and a decline in the synthesis of D in the skin.
104
How to prevent osteoporosis?
Primary prevention strategies include calcium supplementation, vitamin D supplementation, and exercise programs.
105
Folate is required for proper cell division and DNA synthesis, and women with insufficient folate intakes are at increased risk for:
neural tube defects. All women capable of becoming pregnant should obtain adequate amounts of folate (400 daily)
106
What could be a use of Echinacea?
treat or prevent colds, enhance immune system
107
What could be a use of Ginseng?
boost immunity, energy, interacts with Warfarin, digoxin
108
Valerian root?
mild sedative for insomnia or anxiety
109
What could be a use of Ginko Biloba?
Improve memory in dementia patients, increases anti-coagulation.
110
3 water soluble vitamins that can cause toxicity?
niacin, vitamin C, Pyroxidine (B6)
111
Major problem with Pyroxidine?
Medication interactions can cause
112
When should you use a sports drink in rehydration?
In prolonged exercise over an hour
113
What is the most toxic vitamin?
Vitamin A (increased inter-cranial pressure, bulging fontanelles in kids, diplopia, dry skin).
114
After exercise how soon will you want to take carb and protein?
30-45 minutes post workout
115
Signs of hypercalcemia?
Stones, groans, thrones, and psychiatric overtones (which can be caused from D deficiency)
116
Signs of Vitamin E deficiency?
cellebellar functions - proprioception.
117
Advanced chronic kidney disease is the:
most common cause of hypocalcemia (muscle tetany)
118
Describe the sources of energy the body uses as it exercises?
During brief moderate exercise energy comes from a balance of cards and adipose tissues. As it continues, glycogen stores decrease and blood glucose becomes the primary source of CHO energy. If glucose use outdoes gluconeogenesis and glycogen depletes then lipids become the primary source of energy.
119
Symptoms of hyponatremia:
confusion, seizures, and altered mental status with serum sodium levels below 135. Results from intake and retention of water. Would need to check serum and urine and conduct thorough H&P. Start with fluid restriction and maybe administration of isotonic saline.
120
What is Androstenedione?
steroid prohibited by the NCAA due to its ability to cause a false positive for steroid use on urine tests. Is ineffective at building muscle
121
What is creatine?
Though to supply more ATP to the muscles during exercise, can cause weight gain due to water retention. Does not increase muscle mass.
122
What is phosphocreatine?
Good for 10-20 seconds, purpose and AEs are the same as creatine
123
What is the definition of Anorexia?
a BMI of 17.5 or less than 85% of normal for age
124
Subtypes of anorexia?
Nonbinge/nonpurge (not eating anything or exercising a ton) or binge/purge (eating a ton but also getting rid of it
125
What is bulimia?
Consuming an unusually large amount of food and loss of control during eating episodes. Can be purge or nonpurge
126
Purging Bulimia:
Eating a large amount of food and then vomiting, use laxatives, Ipecac, diuretics, diet pills right afterward
127
Nonpurging Bulimia:
Eating an excessive amount of food and then follow with excessive exercise (5 hrs) and then extreme restriction afterward
128
Which type knows they're doing something wrong?
Bulimics, Anorexics think what they're doing is right
129
To diagnose how often does bulimic events have to occur?
At least twice weekly for 3 months
130
Some eating disorders are not otherwise specified and there are 3 subgroups:
Binge Eating Disorder (BED), Sub-threshold cases of AN or BN, and mixed cases
131
Binge Eating Disorder is characterized by large amount of food intake and loss of control, as well as over 3 of the following:
eating very rapidly, feeling uncomfortably full, eating large amounts when not physically hungry, eating alone, feeling disgusted, depressed, or very guilty. No regular use of inappropriate compensatory behaviors (purge or exercise)
132
If an eating disorder does not meet the exact qualifications of AN or BN, they are considered;
NOS, subtype: sub-threshold. IE BMI 18 or over, or not occurring frequently enough
133
The most common type of eating disorder
Mixed cases NOS - has a mix of features of both AN and BN
134
Why is amenorrhea a sign of an AN?
Because when you get below a certain level of fat the body stops your period
135
Common signs and symptoms that you'll see with an eating disorder:
rapid weight loss, secretive eating, wearing baggy clothes, raw fingers, frequent trips to bathroom, hypothermia, bradycardia, hypotension, hypoactive bowel sounds
136
Which psychiatric disorder has the highest mortality rate?
Anorexia Nervosa, also has 50x higher rate of suicide
137
What all needs to be included in treating AN?
Nutritional counseling, Pharmacotherapy + PSYCHOTHERAPY! Need to address the psych issues
138
What are the names based on BMI?
```
<20 = malnutrition
20-25 = normal
25-30 = overweight
30-40 = obese
40+ = severe or morbid obesity
```
139
What are the classes of obesity?
```
I = 30-34.9
II = 35-39.9
III = 40+
```
140
Ghrelin
"hunger hormone" - that stimulates hunger and also lets out Orexin
141
Orexin
from hypothalamus, which makes the appetite to crave food and arousal
142
Which hormone is missing in narcoleptic patients?
Orexin
143
Leptin
What makes you feel full, stops the hypothalmus from making Orexin.
144
What are the 5 components that can lead to Metabolic Syndrome (need 3)
```
HTN
Hyperglycemia
Abdominal Obesity
Low HDLs
High TGs
```
145
Why is Metabolic Syndrome polygenic?
means there is a genetic cause along with a lifestyle cause (poor diet, smoking or drug induced)
146
What are you at immediate risk for if you have metabolic syndrome?
cardiovascular disease, diabetes
147
Risks of being obese?
hypertension, diabetes, hypercholesterolemia, heart disease, breast cancer, prostate cancer, uterine cancer, colon cancer. Also in kids, worry about bowed legs, respiratory apnea
148
What are the 5A's intervention framework used for?
Behavioral counseling with addictions, like smoking and alcohol, but can also be used for weight loss
149
What are the 5As?
```
Assess - BMI at every visit
Advise - behavior change advice
Agree -on treatment goals
Assist - counseling or pharmacotherapy, referrals
Arrange - follow up appts
```
150
Which is the most common surgical treatment for obesity?
Roux-en-Y gastric bypass, attaches directly to jejunum, which interferes with absorption. See the most weight loss but also the most side effects and death. Interferes with fat-soluble vitamins
151
Which surgical treatment of obesity has less side effects but also less effective?
Gastric banding, makes the stomach smaller but lose less weight. Absorption is NOT compromised.
152
Side effects that can occur with gastric surgery?
infection, GI issues (reflux, vomiting), nutritional deficiencies, scarring
153
Inadequate intake of Protein causes:
Kwashiokor. patients are getting enough calories through (rice, etc.), but just not adequate nutrients. Edematous malnutrition will see: peripheral edema, moon facies, protruded abdomen, skin hyperkeratotic (shiny, ulcerated), brittle hair...
154
Physical signs of rickets?
Ricketic rosary on costochondral joints on the ribs is the only way to diagnose in adults with labs. In infants you see the hot cross bun skull and suture lines are prominent.
155
Inadequate intake of protein and calories, causes?
Marasmus. Which is absolute starvation, will see wasting, no muscle, no subq fat, prolonged calorie deficiency
