Nutrition Flashcards
(72 cards)
1
Q
Why are SAM patients more susceptible to infection?
A
Immunosuppression caused by deficiencies in vitamin A, c, zinc and other trace elements
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
3
Q
Most commonly used index For nutritional status?
A
Muac
4
Q
Most severe complication of vitamin K deficiency?
A
Haemorrhagic disease of the newborn
5
Q
How interpret length/height for age z score of 3 or more
A
Very tall
Assess endocrine
6
Q
How interpret length/height for age z score of -2 to -3
A
Stunted
7
Q
How interpret length/height for age z score of -3 or below
A
Severely stunted
8
Q
How interpret weight for age z score of 2 to 3
A
Overweight
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.
10
Q
How interpret weight for age z score of - 2 to - 3
A
Underweight
11
Q
How interpret weight for age z score of - 3 or less
A
Severely underweight
12
Q
How interpret weight for length / height z score of 3 or more
A
Morbidly obese
13
Q
How interpret weight for length / height z score of 2 to 3
A
Obese
14
Q
How interpret weight for length / height z score of 1-2
A
Overweight with possible risk of obesity
15
Q
How interpret weight for length / height z score of - 2 to -3
A
Wasted
16
Q
How interpret weight for length / height z score of - 3 or less
A
Severely wasted
17
Q
How interpret BMI for age z score of 3 or more
A
Morbidly obese
18
Q
How interpret BMI for age z score of 2-3
A
Obese
19
Q
How interpret BMI for age z score of 1-2
A
Overweight with possible risk obesity
20
Q
How interpret BMI for age z score of - 2 to -3
A
Wasted
21
Q
How interpret BMI for age z score of - 3 or less
A
Severely wasted
22
Q
What is and causes koilonychia?
A
Spooning of nails
Iron deficiency
23
Q
What is and causes picture 9?
A
Leukonychia- whitened nail bed
Hypoalbuminaemia
24
Q
What is and causes picture 13
A
Angular cheilitis/stomatitis
Iron or B12 deficiency
25
What is and causes picture 14
Glossitis
Iron/b12/ folate deficiency
26
What is and causes picture 15 (3)
Aphthous ulcers
- benign
- Chron's
- Bechet's disease
27
How plot children < 5 years? (5)
- Weight for age
- length/height for age
- skull circumference
- weight for length
- MUAC
28
How plot children > 5 years? (4)
- Weight for age <10 years old,
- Height for age
- BMI
- skull circumference if indicated
29
Describe nutritional examination (19)
- 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
Name 2 hair signs of PEM
- Colour change and dispigmentation
- quality and texture: thinning, pluckable
31
What nutrient deficiency does alopecia indicate (2)
- Zinc (also will cause thinning pluck able hair)
- Essential fatty acids: linolenic acid ( omega 3 )
32
Name 3 eye signs of vitamin E deficiency
- Jaundice (fat soluble vitamin)
- Retinal degradation
- pallor ( haemolytic anaemia)
33
Name 4 eye signs of vitamin A deficiency
- jaundice
- xerophthalmia (dry conjunctiva/cornea)
- Bitot spots
- Night blindness, conjunctival clouding
34
Name 2 causes periorbital oedema
- PEM
- renal disease
35
Name 4 chest signs of vitamin D deficiency
- Rachitic rosary (widening costochondral junctions)
- sternal deformity
- Harrison's sulcus due to diaphragm pulling in on weak bones
- scoliosis / kyphosis / lordosis
36
Name 2 neuro signs of vitamin e deficiency
- Ataxia (impaired balance, coordination )
- peripheral neuropathy (also vit B6 pyridoxine)
37
Which nutrient deficiency can cause dementia
Niacin B3
38
Name 3 skull signs of vitamin D deficiency
- Large fontanelles, late closure (also down syndrome, iodine deficiency causing hypothyroid, chronic raised ICP, hydrocephalus)
- bossing: frontal and parietal
- Craniotabes (soft bones)
39
Name 3 vitamin B deficiency signs of the mouth and mucous membranes
- Angular stomatitis (riboflavin B2, niacin B3) (also fe)
- tongue: glossitis (B2),
- atrophy and hypertrophy tongue papillae (B3 )
40
Name 2 CVS signs of vitamin B deficiency, and which B vitamin specifically
B1 thiamine
- Cardiomegaly
- cardiac failure (also phosphate, anaemia)
41
Name 3 abdominal signs PEM
- Distention (potbelly-weak abdominal muscles) (also vitamin d. )
- hepatomegaly due to fatty infiltration
- ascites
42
Name 5 types nutritional dermatitis and their causes
- 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
Which nutrient deficiencies cause bruising (2)
- vit C (small diffuse haemorrhages)
- vit K
44
Which nutrient deficiencies cause skin dryness
Vitaman A
45
How interpret weight for age >3
Severely overweight
46
Normal range length/height for age?
> -2 → < 3
47
Normal range weight for age?
< -2 → 1
48
Normal range weight for length/height?
<-2 →1
49
Normal range BMI for age?
<-2→1
50
Define criteria SAM (5)
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
Name criteria for mam (5)
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
Name the WHO ten steps to manage pem
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
8. Provide sensory stimulation and emotional support: day 1-week6
10. Prepare for follow up after recovery
53
Name 4 signs vitamin A deficiency
- Eyes: xerophthalmia, Bitot spots, night blindness
- Immunodeficiency: infections, poor wound healing
- skin pruritis, dry skin
- Acne
54
Name 4 signs vitamin b 12 deficiency
- Pallor: macrocytic megaloblastic anemia
- Hypothyroidism
- cognitive decline
- low energy
55
Name 3 signs vitamin b 1 deficiency
Thiamine.
- neuro: polyneuritis - beri-beri disease
- cardiomyopathy
- indigestion, anorexia
56
Name 4 signs vitamin b 3 deficiency
Niacin.
- dementia
- angular stomatitis
- tongue: hypertrophy of papillae
- dermatitis in sun exposed areas
57
Name 3 signs vitamin b 2 deficiency
Riboflavin.
- angular stomatitis
- glossitis
- dermatitis in sun exposed areas
58
Name 6 signs vitamin C deficiency
- Immunodeficiency
- mucous membrane bleeding eg nosebleeds, gum bleeds
- painful, swollen joints and long bones
- easy bruising
- irritable
- pseudoparalysis of limbs
59
Name 5 signs vitamin D deficiency
- 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
Name 3 signs vitamin E deficiency
- Eyes: retinal degradation
- pallor: haemolytic anaemia in newborn
- Peripheral neuropathy, ataxia
61
Name 4 signs zinc deficiency
- Hair: alopecia, pluckable, thinning
- skin: weeping wet dermatitis
- mouth: angular stomatititis
- immune deficiency
62
Name 3 signs Iron deficiency
- Mouth: angular stomatitis
- pallor: microcytic anaemia
- hands: koilonychia, brittle
63
How prevent hypoglycaemia according to WHO 10 steps of managing sam?
Feed 2 hourly. Start straight away or rehydrate first if necessary.
64
How treat hypoglycaemia according to WHO 10 steps of managing sam? (3)
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
When is the only time you use iv to rehydrate SAM patient? How rehydrate?
If in shock.
Slow 10 ml/kg iv bolus 0,9% normal saline
No more than 4 boluses
66
Treatment dehydration in SAM patients according to WHO 10 steps? (3)
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
Treatment electrolyte imbalance in SAM patients according to WHO 10 steps? (4)
- 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
Prevention infection in SAM patients according to WHO 10 steps? (3)
- 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
How start cautious feeding in SAM patients according to WHO 10 steps? (3)
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
How achieve catch-up growth in SAM patients according to WHO 10 steps? (3)
- 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
Identify picture 23 and name cause
Bitot spot
Vitamin A deficiency
72
What causes pellagra
Vitamin B3 (niacin) deficiency
