Nutrition

Question 1

differnce between food interolerance and food allergy

Answer 1

allergy= immune reaction

intolerance= non immune reaction (e.g. enzyme deficiency)

Question 2

what are the effects of obesity on the skin

Answer 2

reduced mechanical strength and wound healing of the skin due to failure of collagen deposition to larger SA

decreased barrier function= increased transepidermal water loss= dry skin

increased activity of apocrine and eccrine glands in skin fold increases moisture/ skin maceration and friction= irritation

microvascular dysfunction= hypertension

impeded lymphatics

affected hormone production from endocrine role of subcutaneous fat

increased androgens produced in peripheral fat stimulate sebaceous glands

Question 3

what are the direct skin manifestations of obesity

Answer 3

acanthosis nigricans- velvelty thickening and pigmentation of skin folds (assoc. with insulin resistance)

skin tags (assoc. with insulin resistance)

hirsutism (hyperandrogenism)

acne (increased sebaceous gland activity hyperandrogenism)

hidradenitis suppurative- chronic inflamm condition where boils and abscess form and scar in aporcine areas (hyperandrogenism)

stretch marks

Question 4

what skin conditions are aggrevated by obesity

Answer 4

lymphoedema, chronic venous insufficiency, skin infections, intertigo (macerated red plaques which develop in skin folds), psoriasis

Question 5

what is the sequence of events in obesity caused lymphoedema

Answer 5

increased fat impairs lymph drainage

chronic inflammation

fibrosis

reduced tissue oxygenation

bacterial overgrowth

cellulitis

permanently enlarged

Question 6

describe the sequence of events in obesity and chronic venous insufficiency

Answer 6

abdominal fat resists venous return from the legs

veins dilate and valves become incompetent

varicose veins develop

hydrostatic pressure results in leakage into tissue and swelling

haemosiderin pigmentation

inflammation

chronic scarring

venous ulceration

Question 7

what is the role, source, deficiency presentation and test needed for diagnoisis of vitamin A

Answer 7

role; epithelial proliferation, keratinisation and development

animal produce and bright fruit and veg

keratotic follicular papules of thighs and upper arms, dry skin

measure serum vit A

Question 8

what is the role, source, deficiency presentation and test needed for diagnoisis of vitamin K

Answer 8

role; coagulation factors

source- green leafy veg, liver, veg oils

presentation- bleeding tendancy, purpura, easy bruising

diagnosis; measure coagulation and serum vit k

Question 9

what is the role, source, deficiency presentation and test needed for diagnoisis of vitamin B2 (riboflavin)

Answer 9

metabolic reaction

animal produce, leafy veg

cheilosis, angular stomatitis, painful red dry tongue

measure activity of EGR

Question 10

what is the role, source, deficiency presentation and test needed for diagnoisis of vitamin B3 (niacin)

Answer 10

metabolic reactions

meat fish nuts coffee

pellagra

clinical diagnosis

Question 11

what are the 4 d’s of pellagra

Answer 11

dermatitis, delirium, diarrhoea, death

Question 12

what is the source, deficiency presentation and test needed for diagnoisis of vitamin B6

Answer 12

meats, cereals, milk, ,potatoes, bananas, nutes, pulses

dermatitis, glossitis

measure serum urinary vit B6

Question 13

what is the source, deficiency presentation and test needed for diagnoisis of folate

Answer 13

liver, green veg, beans, nuts, milks

anaemia, angular stomatitis, glossitis, hair depigmentation, skin and mucous membrane pigmentation

measure serum folate

Question 14

what is the source, deficiency presentation and test needed for diagnoisis of vitamin B12

Answer 14

only from animal sources

anaemia, angular stomatitis, glossitis, hair depigmentation, skin and mucous membrane pigmentation, neurological conditions

measure serum vit B12

Question 15

what is the source, deficiency presentation and test needed for diagnoisis of vitamin Biotin

Answer 15

cereals, meat, eggs, milk, pulses, nuts

rare (malabsorptive states)- facial dermatitis, glossitis, alopecia

measure serum biotin

Question 16

what is the role, source, deficiency presentation and test needed for diagnoisis of vitamin C

Answer 16

co factor in collagen formation

cirtus fruit, strawberries, blackcurrants, tomatoes, potatoes

hyperkeratosis around hair follicles, bent hairs, inflamed gums, poor wound healing, fatigue, malaise, muscle and bone pain

clinical diagnosis

Question 17

what is the role, source, deficiency presentation and test needed for diagnoisis of zinc

Answer 17

structure and func of skin, wound healing

meat, fish, milk, eggs, cereals, nuts, pulses

acrodermatitis (genetic)
acquired- dermatitic rash of hands and feet, growth retardation

measure serum zinc

Question 18

name and describe the two kinds of protein energy malnutrition

Answer 18

marasmus- weight loss by fat breakdown, very thin child, muscle wasting, dry wrinkled skin, thin brittle hair that falls out

kwashiorkor; low protein and reasonable carb intake, oedema (kids with pot bellys), irregular skin discolouration. dark dry skin may split revealing pale areas (crazy paving dermatosis)

Question 19

what are the signs of IgE mediated allergies

Answer 19

skin; pruritus, erythema, acute uticaria, acute angioedema

GI; angioedema (of lips, tongues, palate), oral pruritus, nausea, colicky abdominal pain, vomiting, diarrhoea

resp; nasal itching, sneezing, rhinorrhoea, congestion, cough, chest tightness, wheezing, SOB

symptoms of anaphalyxis or other systemic allergic reactions

Question 20

what are the symptoms of non IgE mediated allergic reactions

Answer 20

pruritus, erythema, atopic eczema,

reflux, loose or frequent stools, blood and/or mucous in stools, abdo pain, infantile colic, food refusal or aversion, constipation, perianal redness, pallor and tiredness,

faltering growth

Question 21

describe the basic onsets of IgE and non IgE mediated reactions

Answer 21

IgE- immediate, acute

non IgE- delayed, non acute

Question 22

what happens if after tests a non IgE mediated allergy is suspected

Answer 22

trail removal of the allergen for between 2-6 weeks then reintroduction

Question 23

when should you consider referral for a suspected allergy

Answer 23

if child/ young person has;

• faltering growth with one or more GI symptoms
• had one/more acute systemic reactions or severe delayed reactions
• significant atopic eczema or suspected multiple allergies

after diagnosis refer if

• doesnt improve
• has confirmed allergy and concurrent asthma

or refer if tests are negative by high clinical suspicion of an allergy

Question 24

name a photosensitive deficiency

Answer 24

niacin

Question 25

what is the prevalence of food allergy in children

Answer 25

> 10%

Question 26

what are the most common allergens for children

Answer 26

wheat, diary, nuts, egg, soya, peanuts, fish, shellfish

Question 27

how does obesity cause thickening of leg skin

Answer 27

weight puts pressure on veins and lymph, insufficient return, lymphoedema, stasis, pathogens stay, inflammation, infection, scarring, fibrosis, hardening

Question 28

how do you treat lymphoedema and cellulitis

Answer 28

compression stockings, increase movement, antibiotics (prophylaxis), weight loss, hygiene, emollients, antiseptics

Question 29

what skin conditions does diabetes increase your risk of

Answer 29

acanthosis

skin tas

Question 30

what skin conditions does obesity increase your risk of

Answer 30

acne
hirstutism
psoriasis