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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
Def anorexia
a disturbance in body image and intense fear of weight gain
26
Clinical anorexia
- 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
Dx anorexia
- 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
Tx anorexia
- 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
Def bulimia nervosa
``` 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
Clinical bulimia nervosa
- 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
Tx bulimia
- 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
Serum ferritin levels in iron deficiency
Serum ferritin value <12 ng/mL without anemia or <30 ng/mL with anemia
33
Stage of iron deficient anemia
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
Clinical iron deficient anemia
- Fatigue - Tachycardia - Palpitations - Dyspnea on exertion - Skin and mucosal changes - Smooth tongue - Brittle nails - Spooning of nails - Cheilosis - pica
35
Tx iron deficient anemia
- 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
Who get parenteral iron
Refractory to PO iron
 GI disease Hemodialysis
37
Thiamine deficiency due to
chronic alcoholism
38
Clinical thiamine deficiency
- Anorexia - Muscle cramps - Paresthesias - Irritability - Cardiovascular dysfunction – wet beriberi - Neurological dysfunction – dry beriberi
39
Wet beriberi
- Marked peripheral vasodilation caused high output heart failure - Dyspnea, tachycardia, cardiomegaly, edema
40
Dry beriberi
- Peripheral nerve involvement causing motor and sensory neuropathy, 
paresthesias and loss of reflexes - Wernicke - Korsakoff Syndrome
41
Tx thiamine deficiency
replace thiamine, initially IV followed by PO
42
Where is B12 from?
animal sources
43
How is B12 absorbed
intrinsic factor in the intestine and stored in liver
44
B12 deficiency in
vegans, alcoholics, elderly
45
Pernicious anemia
autoimmune disease where there are autoantibodies against gastric parietal cells that produce intrinsic factor
46
What surgery eliminates intrinsic factor
Gastrectomy
47
B12 anemia
- elevated MCV (MCV >100) (macrocytic) | - megaloblastic and hypersegmented neutrophils
48
Tx B12
IM or subcutaneous injections of 100 mcg • Daily for first week • Weekly for first month • Monthly for life
49
Folic acid found
fruit and vegetable
50
Folic acid deficiency due to
lack of intake
51
Clinical B12 and folate
- GI symptoms
 - Swollen, painful tongue - Neurologic symptoms such as cognitive impairment, dementia, depression
52
Diagnostic level folic acid
less than 150
53
Tx folic acid deficiency
folic acid 1mg PO daily
54
Vit D found
ultraviolet B light, plants, animals, fish
55
Vit D converted into
Hormone 1,25- dihydroxyvitamin D
56
Hormone 1,25- dihydroxyvitamin D does what
increases absorption of dietary calcium and stimulate osteoclast to release calcium
57
MC manifestation of Vit D deficiency
osteomalacia
58
Tx Vit D
``` 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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