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Nutrition Flashcards

1
Q

Why are SAM patients more susceptible to infection?

A

Immunosuppression caused by deficiencies in vitamin A, c, zinc and other trace elements

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2
Q

During acute illness, how is a child’s growth affected?

A

Loss of weight due to poor intake and decrease in adipose tissue

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3
Q

Most commonly used index For nutritional status?

A

Muac

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4
Q

Most severe complication of vitamin K deficiency?

A

Haemorrhagic disease of the newborn

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5
Q

How interpret length/height for age z score of 3 or more

A

Very tall

Assess endocrine

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6
Q

How interpret length/height for age z score of -2 to -3

A

Stunted

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7
Q

How interpret length/height for age z score of -3 or below

A

Severely stunted

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8
Q

How interpret weight for age z score of 2 to 3

A

Overweight

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9
Q

How interpret weight for age z score of 1 to 2

A

Possible growth problem

Better assed from weight for height or BMI for age.

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10
Q

How interpret weight for age z score of - 2 to - 3

A

Underweight

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11
Q

How interpret weight for age z score of - 3 or less

A

Severely underweight

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12
Q

How interpret weight for length / height z score of 3 or more

A

Morbidly obese

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13
Q

How interpret weight for length / height z score of 2 to 3

A

Obese

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14
Q

How interpret weight for length / height z score of 1-2

A

Overweight with possible risk of obesity

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15
Q

How interpret weight for length / height z score of - 2 to -3

A

Wasted

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16
Q

How interpret weight for length / height z score of - 3 or less

A

Severely wasted

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17
Q

How interpret BMI for age z score of 3 or more

A

Morbidly obese

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18
Q

How interpret BMI for age z score of 2-3

A

Obese

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19
Q

How interpret BMI for age z score of 1-2

A

Overweight with possible risk obesity

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20
Q

How interpret BMI for age z score of - 2 to -3

A

Wasted

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21
Q

How interpret BMI for age z score of - 3 or less

A

Severely wasted

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22
Q

What is and causes koilonychia?

A

Spooning of nails
Iron deficiency

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23
Q

What is and causes picture 9?

A

Leukonychia- whitened nail bed
Hypoalbuminaemia

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24
Q

What is and causes picture 13

A

Angular cheilitis/stomatitis
Iron or B12 deficiency

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25
Q

What is and causes picture 14

A

Glossitis
Iron/b12/ folate deficiency

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26
Q

What is and causes picture 15 (3)

A

Aphthous ulcers
- benign
- Chron’s
- Bechet’s disease

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27
Q

How plot children < 5 years? (5)

A
  • Weight for age
  • length/height for age
  • skull circumference
  • weight for length
  • MUAC
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28
Q

How plot children > 5 years? (4)

A
  • Weight for age <10 years old,
  • Height for age
  • BMI
  • skull circumference if indicated
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29
Q

Describe nutritional examination (19)

A
  • Introduce etc
  • anthropometry
  • milestones
  • General inspection: sick/well, posture, chronic/acute, attachments, apathy/irritability
  • vitals: hr, rr, bp (chart), temperature, sats, glucose
  • hair: thinning, pluckable, colour change and dispigmentation, alopecia
  • head: fontanelles, bossing, craniotabes,
  • eyes: sunken/bulging, jaccold, dry/xerosis, conjunctival clouding, keratomalacia / perforation, pacification, bitot spots, periorbital oedema
  • lips: angular stomatitis, cheilosis, dry
  • mouth: dental caries, bleeding gums, loose teeth, delayed eruption teeth, glossitis/red/ulceration, mucous membranes
  • neck: rash string of beads (vellagra), goitre
  • skin: pallor, bruising, dryness, dermatitis (peeling flakey; eczema; weeping; rough scaly where sun exposed; erythema nodosum)
  • upper limbs: jaccold, nails koilonychia and brittle, cap refill, widening wrists, pain long bones, subcutaneous fat and muscle bulk
  • chest and back: Vit d- rib rosary, sternal deformity, Harrison sulcus, scoliosis/kyphosis/ lordosis
  • CVS: vit B1: cardiomegaly, cardiac failure
  • Abdo: PEM - distention, ascites, hepatomegaly due to fatty infiltration
  • inguinal: pubertal delay, nappy rash PEM (involve skin folds) vs contact dermatitis (spares) , perianal rash, baggy pants sign
  • lower limbs: fat and muscle, sacral edema, widening ankles, deformities weight bearing bones eg bow legs, X legs, windswept legs, plantar surface feet, nails, long bone tender
  • gait eg ataxia = vit e deficiency
30
Q

Name 2 hair signs of PEM

A
  • Colour change and dispigmentation
  • quality and texture: thinning, pluckable
31
Q

What nutrient deficiency does alopecia indicate (2)

A
  • Zinc (also will cause thinning pluck able hair)
  • Essential fatty acids: linolenic acid ( omega 3 )
32
Q

Name 3 eye signs of vitamin E deficiency

A
  • Jaundice (fat soluble vitamin)
  • Retinal degradation
  • pallor ( haemolytic anaemia)
33
Q

Name 4 eye signs of vitamin A deficiency

A
  • jaundice
  • xerophthalmia (dry conjunctiva/cornea)
  • Bitot spots
  • Night blindness, conjunctival clouding
34
Q

Name 2 causes periorbital oedema

A
  • PEM
  • renal disease
35
Q

Name 4 chest signs of vitamin D deficiency

A
  • Rachitic rosary (widening costochondral junctions)
  • sternal deformity
  • Harrison’s sulcus due to diaphragm pulling in on weak bones
  • scoliosis / kyphosis / lordosis
36
Q

Name 2 neuro signs of vitamin e deficiency

A
  • Ataxia (impaired balance, coordination )
  • peripheral neuropathy (also vit B6 pyridoxine)
37
Q

Which nutrient deficiency can cause dementia

38
Q

Name 3 skull signs of vitamin D deficiency

A
  • Large fontanelles, late closure (also down syndrome, iodine deficiency causing hypothyroid, chronic raised ICP, hydrocephalus)
  • bossing: frontal and parietal
  • Craniotabes (soft bones)
39
Q

Name 3 vitamin B deficiency signs of the mouth and mucous membranes

A
  • Angular stomatitis (riboflavin B2, niacin B3) (also fe)
  • tongue: glossitis (B2),
  • atrophy and hypertrophy tongue papillae (B3 )
40
Q

Name 2 CVS signs of vitamin B deficiency, and which B vitamin specifically

A

B1 thiamine
- Cardiomegaly
- cardiac failure (also phosphate, anaemia)

41
Q

Name 3 abdominal signs PEM

A
  • Distention (potbelly-weak abdominal muscles) (also vitamin d. )
  • hepatomegaly due to fatty infiltration
  • ascites
42
Q

Name 5 types nutritional dermatitis and their causes

A
  • dry dermatitis: Peeling, flakey paint-PEM
  • wet dermatitis: weeping lesions -PEM, zinc
  • pellagra dermatitis: rough, scaly skin in sun exposed areas, string of beads around neck (3 ds: dermatitis, diarrhoea, dementia) -B3 niacin
  • erythema nodosum: tender red bumps on shins - Chrons, uc
  • Eczema like dermatitis: esp mouth and anus - zinc
43
Q

Which nutrient deficiencies cause bruising (2)

A
  • vit C (small diffuse haemorrhages)
  • vit K
44
Q

Which nutrient deficiencies cause skin dryness

45
Q

How interpret weight for age >3

A

Severely overweight

46
Q

Normal range length/height for age?

A

> -2 → < 3

47
Q

Normal range weight for age?

A

< -2 → 1

48
Q

Normal range weight for length/height?

49
Q

Normal range BMI for age?

50
Q

Define criteria SAM (5)

A

Age 6 months to 5 years

  • weight for height <-3 or
  • height for age < -3 or
  • bilateral pitting oedema of nutritional origin or
  • muac <11,5 cm children 1-5 years
51
Q

Name criteria for mam (5)

A

Age 6 months to 5 years

  • weight for height -3 → -2 or
  • height for age -3 → -2 or
  • oedema of nutritional origin (non - pitting, not necessarily bilateral) or
  • muac 11,5 -12,5 cm children 1-5 years
52
Q

Name the WHO ten steps to manage pem

A

Hungry Humans Die Early If Mothers Forget to Cook Some Food

  1. Treat/prevent Hypoglycaemia: day 1-2
  2. Hypothermia
  3. Dehydration
  4. Correct electrolyte imbalance
  5. Treat/prevent infection: day 1- week 6
  6. Correct micronutrient deficiencies (no iron until day 14, can start iron from week 2)
  7. Start cautious feeding
  8. Achieve catch-up growth: week 2-6
  9. Provide sensory stimulation and emotional support: day 1-week6
  10. Prepare for follow up after recovery
53
Q

Name 4 signs vitamin A deficiency

A
  • Eyes: xerophthalmia, Bitot spots, night blindness
  • Immunodeficiency: infections, poor wound healing
  • skin pruritis, dry skin
  • Acne
54
Q

Name 4 signs vitamin b 12 deficiency

A
  • Pallor: macrocytic megaloblastic anemia
  • Hypothyroidism
  • cognitive decline
  • low energy
55
Q

Name 3 signs vitamin b 1 deficiency

A

Thiamine.

  • neuro: polyneuritis - beri-beri disease
  • cardiomyopathy
  • indigestion, anorexia
56
Q

Name 4 signs vitamin b 3 deficiency

A

Niacin.

  • dementia
  • angular stomatitis
  • tongue: hypertrophy of papillae
  • dermatitis in sun exposed areas
57
Q

Name 3 signs vitamin b 2 deficiency

A

Riboflavin.

  • angular stomatitis
  • glossitis
  • dermatitis in sun exposed areas
58
Q

Name 6 signs vitamin C deficiency

A
  • Immunodeficiency
  • mucous membrane bleeding eg nosebleeds, gum bleeds
  • painful, swollen joints and long bones
  • easy bruising
  • irritable
  • pseudoparalysis of limbs
59
Q

Name 5 signs vitamin D deficiency

A
  • Skull: craniotabes, fontanelles large and late closure, bossing
  • mouth: delayed eruption teeth
  • bones: rachitic rosary, scoliosis, lordosis, genus valgus, sternal deformity
  • upper limbs: wrist widening (rickets)
  • abdominal distention - weak abdo muscles
  • hypotonia, muscle weakness
60
Q

Name 3 signs vitamin E deficiency

A
  • Eyes: retinal degradation
  • pallor: haemolytic anaemia in newborn
  • Peripheral neuropathy, ataxia
61
Q

Name 4 signs zinc deficiency

A
  • Hair: alopecia, pluckable, thinning
  • skin: weeping wet dermatitis
  • mouth: angular stomatititis
  • immune deficiency
62
Q

Name 3 signs Iron deficiency

A
  • Mouth: angular stomatitis
  • pallor: microcytic anaemia
  • hands: koilonychia, brittle
63
Q

How prevent hypoglycaemia according to WHO 10 steps of managing sam?

A

Feed 2 hourly. Start straight away or rehydrate first if necessary.

64
Q

How treat hypoglycaemia according to WHO 10 steps of managing sam? (3)

A

If child conscious and dextrostix show < 3 give
- Immediate feed df -75 or start up formula
Or
- 10% sugar solution oral 5 ml/kg
Or
- dextrose 10% iv bolus

Monitor blood glucose and repeat hourly until normal. Most stabilise after 30 min.

If remain < 3 give iv bolus dextrose water 5 ml /kg

65
Q

When is the only time you use iv to rehydrate SAM patient? How rehydrate?

A

If in shock.
Slow 10 ml/kg iv bolus 0,9% normal saline
No more than 4 boluses

66
Q

Treatment dehydration in SAM patients according to WHO 10 steps? (3)

A

Always oral (or ngt) unless in shock.

  • SOROL 5 ml/kg every 30 minutes for 2 hours
  • then 5 - 10 ml/kg/h for next 4-10 hours
  • replace SOROL doses at 4,6 8 and 10 hours with f-75 rehydration; then continue feeding starter f-75

Stop according to what child wants, stool loss, vomiting.

67
Q

Treatment electrolyte imbalance in SAM patients according to WHO 10 steps? (4)

A
  • Don’t treat low sodium with iv fluids, can cause death from sodium overload and heart failure.
  • don’t treat oedema with diuretics

Supplement
- Potassium 25 - 50 mg/kg/dose 8 hourly
- magnesium < 10 kg 2,5 ml daily; > 10 kg 5 ml daily

68
Q

Prevention infection in SAM patients according to WHO 10 steps? (3)

A
  • Ampicillin iv /im 50mg / kg for 2 days, then oral amoxicillin 30 mg/kg 8 hourly 5 days
    And
  • aminoglycoside: gentamicin or amikacin (15 mg/kg once daily iv 7 days)
69
Q

How start cautious feeding in SAM patients according to WHO 10 steps? (3)

A

If appetite and no oedema: can complete following schedule in 2-3 days, 24 hours at each level.
- Day 1-2: 2 hourly df -75 130ml/kg/day
- day 3-5: 3 hourly 130
- day 6-7+: 4 hourly 130

Increase volume slowly until 150ml/kg/day

70
Q

How achieve catch-up growth in SAM patients according to WHO 10 steps? (3)

A
  • When appetite has returned
  • replace starter df -75 with same amount catch-up formula df-100 for 48 hours
  • increase each successive feed by 10 ml until some feed remains uneaten
71
Q

Identify picture 23 and name cause

A

Bitot spot

Vitamin A deficiency

72
Q

What causes pellagra

A

Vitamin B3 (niacin) deficiency

Paediatrics (15 decks)

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