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Clin Med 2 > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Energy comes from

A

o Carbohydrate
o Fiber
o Nitrogen
o Water

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2
Q

Energy supports

A

normal functions and activity, growth and repair of damaged tissues

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3
Q

Three factors for Energy Expenditure

A

o Basal energy expenditure (BEE)
o Thermic effect of food (TEF)
o Physical activity

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4
Q

Basal energy expenditure (BEE)

A

amount of energy required to maintain basic physiologic functions

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5
Q

Thermic effect of food (TEF)

A

amount of energy expended during and following the ingestion of food

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6
Q

Of the energy expenditures, which has the largest effect

A

physical activity

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7
Q

Why do we need protein

A

growth and maintenance of body structure and function

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8
Q

How much protein a day

A

56g/day for men and 45g/day women

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9
Q

Carbs include

A

o Simple sugars
o Complex carbohydrates (starches)
o Indigestible carbohydrates (dietary fiber)

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10
Q

What is the most concentrated source of food energy

A

fat

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11
Q

What is major part of cell membranes

A

cholesterol

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12
Q

Patient populations at risk of nutritional deficiencies

A

o Elderly
o Adolescent
o Pregnant or lactating women
o Low socioeconomic status

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13
Q

BMI

A

body weight in relation to height

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14
Q

Most important lab in evaluation of protein-calorie undernutrition

A

albumin

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15
Q

2 distinct syndromes of protein- energy malnutrition

A

Kwashiorkor

Marasmus

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16
Q

Kwashiorkor

A
  • deficiency of protein in presence of adequate energy

- Sufficient caloric intake, insufficient protein consumption

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17
Q

Marasmus

A
  • combined protein and energy deficiency

- Severe malnutrition, emaciated appearance

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18
Q

In developing countries where is Kwashiorkor found

A
  • where foods containing protein are insufficient

- Occurs in areas of famine or poor food supply

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19
Q

In developing countries where is Marasmus found

A

seen where adequate quantities of food are not available

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20
Q

In developed countries where is Kwashiorkor found

A

associated with illnesses where the body is in a hypermetabolic state, i.e. trauma, sepsis, burns

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21
Q

In developed countries where is Marasmus found

A

results from chronic diseases like heart failure, cancer, COPD, AIDS 
Protein-Energy Malnutrition

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22
Q

Tx protein energy malnutrition

A

Call your nutrition colleagues ASAP
Should be followed daily by nutrition consultant
o Help manage dietary requirements
o Correct electrolyte abnormalities
o Replace vitamins and minerals
o Supplements with enteral or parenteral nutrition

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23
Q

obesity is

A

excess adipose tissue

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24
Q

Tx obesity

A
  • Close follow-up is essential
  • Identify and refer those patients who are motivated to active 
treatment programs
  • Programs are multifactorial and emphasize maintenance of weight loss
    o Dietary instruction and education
    o Behavior modification
    o Exercise
    o Medications
    o Bariatric surgery
25
Q

Def anorexia

A

a disturbance in body image and intense fear of weight gain

26
Q

Clinical anorexia

A
  • Weight loss leading to body weight 15% below expected
  • In female patients, amenorrhea is almost always present
  • Other clinical signs and symptoms:
    o Constipation
    o Cold intolerance
    o Bradycardia
    o Hypotension
    o Loss of body fat
    o Dry and scaly skin 

27
Q

Dx anorexia

A
  • Behavioral features such as distorted body image, fear of weight gain and refusal to maintain normal body weight in setting of weight loss to a body weight 15% below expected
  • In female, absence of at least 3 menstrual cycles
28
Q

Tx anorexia

A
  • Goal is restoration of normal body weight and elimination of psychological features
  • Inpatient treatment programs are available but may also be necessary in severe cases for management of volume status and electrolytes
  • Referral to psychiatrist is essential 

29
Q

Def bulimia nervosa

A 
Episodic, uncontrolled ingestion of large quantities of food followed by recurrent inappropriate compensatory behavior to avoid weight gain
o	Self-induced vomiting
o	Diuretics
o	Cathartics
o	Strict dieting
o	Vigorous exercise
30
Q

Clinical bulimia nervosa

A
  • Body weight fluctuations but generally within 20% of normal body weight
  • Commonly describe family and psychological issues
  • Impulsive or antisocial behavior may be present
  • Menstruation is typically preserved
  • Medical complications such as:
    o Gastric dilatation, pancreatitis after binges
    o Poor dentition, esophagitis secondary to vomiting
    o Electrolyte abnormalities, dehydration secondary to diuretics and cathartics
    o Constipation
31
Q

Tx bulimia

A
  • Supportive care to include psychotherapy
  • Antidepressants may be helpful
  • All patients should be referred to psychiatrist
  • Long term psychiatric prognosis is worse with bulimia nervosa
32
Q

Serum ferritin levels in iron deficiency

A

Serum ferritin value <12 ng/mL without anemia or <30 ng/mL with anemia

33
Q

Stage of iron deficient anemia

A
  1. Depletion of iron stores without anemia
  2. Anemia with a normal red blood size (MCV)
  3. Anemia with low MCV (microcytic), low reticulocyte count , low serum ferritin
34
Q

Clinical iron deficient anemia

A
  • Fatigue
  • Tachycardia
  • Palpitations
  • Dyspnea on exertion
  • Skin and mucosal changes
  • Smooth tongue
  • Brittle nails
  • Spooning of nails
  • Cheilosis
  • pica
35
Q

Tx iron deficient anemia

A
  • Identify cause of iron deficiency anemia as often this can be a result of occult blood loss
  • Oral iron
    o Ferrous sulfate 325 mg PO one-three times daily
    o Continue 3-6 months after restoration of normal labs
36
Q

Who get parenteral iron

A

Refractory to PO iron

GI disease
Hemodialysis

37
Q

Thiamine deficiency due to

A

chronic alcoholism

38
Q

Clinical thiamine deficiency

A
  • Anorexia
  • Muscle cramps
  • Paresthesias
  • Irritability
  • Cardiovascular dysfunction – wet beriberi
  • Neurological dysfunction – dry beriberi
39
Q

Wet beriberi

A
  • Marked peripheral vasodilation caused high output heart failure
  • Dyspnea, tachycardia, cardiomegaly, edema
40
Q

Dry beriberi

A
  • Peripheral nerve involvement causing motor and sensory neuropathy, 
paresthesias and loss of reflexes
  • Wernicke - Korsakoff Syndrome
41
Q

Tx thiamine deficiency

A

replace thiamine, initially IV followed by PO

42
Q

Where is B12 from?

A

animal sources

43
Q

How is B12 absorbed

A

intrinsic factor in the intestine and stored in liver

44
Q

B12 deficiency in

A

vegans, alcoholics, elderly

45
Q

Pernicious anemia

A

autoimmune disease where there are autoantibodies against gastric parietal cells that produce intrinsic factor

46
Q

What surgery eliminates intrinsic factor

A

Gastrectomy

47
Q

B12 anemia

A
  • elevated MCV (MCV >100) (macrocytic)

- megaloblastic and hypersegmented neutrophils

48
Q

Tx B12

A

IM or subcutaneous injections of 100 mcg
• Daily for first week
• Weekly for first month
• Monthly for life

49
Q

Folic acid found

A

fruit and vegetable

50
Q

Folic acid deficiency due to

A

lack of intake

51
Q

Clinical B12 and folate

A
  • GI symptoms

  • Swollen, painful tongue
  • Neurologic symptoms such as cognitive impairment, dementia, depression
52
Q

Diagnostic level folic acid

A

less than 150

53
Q

Tx folic acid deficiency

A

folic acid 1mg PO daily

54
Q

Vit D found

A

ultraviolet B light, plants, animals, fish

55
Q

Vit D converted into

A

Hormone 1,25- dihydroxyvitamin D

56
Q

Hormone 1,25- dihydroxyvitamin D does what

A

increases absorption of dietary calcium and stimulate osteoclast to release calcium

57
Q

MC manifestation of Vit D deficiency

A

osteomalacia

58
Q

Tx Vit D

A 
o	Ergocalciferol (D2) 50,000 units once weekly x8 weeks
o	Cholecalciferol (D3) 2,000 units daily

Clin Med 2 (25 decks)

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