Nutrition

Question 1

Breastmilk at the START of feeding

watery

HIGH lactose and protein

Answer 1

FOREMILK

Question 2

Breastmilk as feeding progresses until towards the end of feeding

creamy

HIGH fat

Answer 2

HINDMILK

Question 3

Stages of Lactation

Answer 3

Colostrum (first 0-7 days)

• PROTEIN rich
• rich in IgA
• high in IgG/protective factors - lactoferrin, lysozyme

Transitional milk

• b/w colostrum and mature milk
• rising levels of macronutrients

Mature milk

• D10-14 of life
• colostrum content + high fat and lactose

Involutionary milk
*produced when breastfeeding frequency decreases

Question 4

Whey to casein ratio in mature human milk

Answer 4

3:2

Question 5

Breastmilk has MORE compared to formula milk EXCEPTIONS

Answer 5

Iron
Vitamin D
Vitamin K

Question 6

Infants condition PEAK at 4 mos and resolve mostly at 12 mos and nearly all at 24 mos

(+) postprandial regurgitation, signs of esophagitis (irritability, arching, choking, gagging, feeding aversion), failure to thrive

Answer 6

GERD

Question 7

Definitive test for GERD

Answer 7

Esophageal pH probe

Question 8

Diagnosis for GERD

Answer 8

Barium study of esophagus and upper GIT (poor sensitivity and specificity)

Question 9

Contraindications to Breastfeeding

Answer 9

Galactosemia
Septicemia
Active TB
Breast cancer
Malaria
Substance abuse
Severe neurosis or psychosis
HIV

Question 10

Vesiculobulbous, ECZEMATOUS, dry scaly or PSORIAFORM lesions, symmetric PERIORAL, SACRAL and PERIANAL areas

Answer 10

Zinc Deficiency

Chronic diarrhea,
Stomatitis	
Glossitis
Irritability
superinfection

Question 11

Generalized scaly
dermatitis

Alopecia
Thrombocytopenia,
Failure to thrive

Answer 11

Essential Fatty Acids

Question 12

Edema, erythema and

burning of sun exposed skin on the face neck hands on butterfly distribution dermatitis around the neck

Answer 12

Niacin (Pellagra)/Vitamin B3

Diarrhea
Dementia
Niacin

Question 13

Alopecia w/ neurological symptoms

Answer 13

Biotin/Vitamin B7

Question 14

Follicular hyperkeratosis

Xerosis, Night blindness

Answer 14

Vitamin A

Question 15

Follicular hyperkeratosis
Perifollicular erythema and hemorrhage
Bleeding swollen gums

Answer 15

Vitamin C

Question 16

Retinal pigments
Bone
Tooth and Epithelium development

90% BA in breast milk
prematures more vulnerable

Answer 16

Vitamin A

Question 17

Bone formation
Rickets and Osteomalacia

Content in breastmilk DEPENDS on maternal status

Answer 17

Vitamin D

Question 18

RBC hemolysis in premature infants

Anti-oxidant

Answer 18

Vitamin E

Question 19

VKDB

Prevented by prophylaxis

Answer 19

Vitamin K

Question 20

Affects bones and joints
Perifollicular hemorrhages
Gum swelling

Scurvy

Answer 20

Vitamin C

Question 21

Stores are adequate for 6 mos

Content in breastmilk NOT affected by maternal status

Answer 21

Iron

Zinc

Question 22

Content in breastmilk DEPENDS on maternal status

Answer 22

Iodine

Question 23

Beri beri

Answer 23

B1 (Thiamine)

Question 24

Nonspecific (cheilosis, glossitis)

Answer 24

B2 (Riboflavin)

Question 25

Pellagra

Answer 25

B3 (Niacin)

Question 26

Microcytic anemia + estrogen pills

Answer 26

B6 (Pyridoxine)

Question 27

Alopecia + neurologic changes

Answer 27

B7 (Biotin)

Question 28

Megaloblastic anemia

Answer 28

B9 (Folic acid)

Question 29

Megaloblastic anemia + Neurologic deficit

Answer 29

B12 (Cobalamin)

Question 30

``` Bowlegs or knock knees Caput quadratum, Periosteal osteoid Craniotabes Ping pong ball sensation Rachitic rosary, pigeon chest Harrison groove ```

Answer 30

Vitamin D -- RICKETS

Question 31

White line on end of shafts | Scorbutic rosary beads

Answer 31

Vitamin C

Question 32

Pellagra Casal necklace Pellagrous glove and boots Glove and boots lesion

Answer 32

Vitamin B3 (Niacin)

Question 33

Perleche

Answer 33

Vitamin B2 (Riboflavin)

Question 34

Bitot spots Xerosis conjunctivae Xerosis cornea

Answer 34

Vitamin A deficiency

Question 35

Hyperostosis | Absence of metaphyseal changes

Answer 35

Vitamin A intoxication