Nutrition

Question 1

A third of all deaths in children under 5?

Answer 1

Malnutrition

Question 2

Causes of malnutrition ?

Answer 2

Preterm
CKD
Short gut syndrome (bowel resection or IBD)
Cerebral palsy
CHD
Malignant disease or chemotherapy

Question 3

Anthropometric nutritional assessment ?

Answer 3

Weight
Height
MUAC mid upper arm circumference
Skinfold thickness

Question 4

When is MUAC severe?

Answer 4

Red

Less than 115 mm

Question 5

What MUAC reflects?

Answer 5

Skeletal muscle mass
Screening for malnutrition
Independent of age

Question 6

When is enteral good by jejnum needed?

Answer 6

When there is vomiting

Question 7

When to consider gastrostomy?

Answer 7

When enteral nutrition is required more than 6 weeks

Question 8

What is provided in parenteral nutrition?

Answer 8

Energy in the form of glucose (plus fat emulsion)
Nitrogen in AA resembling egg protein
Vitamins and trace elements
Electrolytes 
Macronutrients

Question 9

Side effect of PN?

Answer 9

Zinc deficiency causing erythematous rash around mouth and anus.
Monitor

Question 10

Reasons for long term PN?

Answer 10

Enteropathy (severe diarrhea in early life)
Long segment hirschpung disease
Short bowel (from gastoschisis or volvulus)

Question 11

PN short term given in?

Long term? And why?

Answer 11

Short peripheral vein

Long centeral venous catheter (reliable venous access and allows infusion of hyperosmolar solutions)

Question 12

Complications of CVC PN?

Answer 12

Sepsis
Blockage
Venous thrombus
Intestinal failure associated liver disease

Question 13

Weight for height is a measure of what? Reflects?

Answer 13

Measure of wasting

Acute malnutrition

Question 14

Height for age a measure of? Reflects?

Answer 14

Measure of stunting

Index of chronic malnutrition

Question 15

In severe protein and energy malnutrition they are predisposed to deficiency in ?

Answer 15

K
Zinc
Mg
Vitamin A

Question 16

Who oral rehydration solutions problem?

Instead give?

Answer 16

Contains high sodium 75+ mmol/L
But low K
ReSomal

Question 17

IV fluids only needed?

Answer 17

In shock

Question 18

Introduction of iron in severe malnutrition ?

Answer 18

Delayed to 2 weeks!

Question 19

Risk of stunting?

Answer 19

Obese adults
Non communicable disease
Susceptible to illness
Fall behind in school

Question 20

Vitamin D deficiency results from?

Answer 20

UVB inadequate exposure
Deficient intake
Defective metabolism of VD

Question 21

If VD deficiency didn’t present with classical rockets how could they present? When is this commonly seen?

Answer 21

Symptoms of hypocalcemia
Seizures
Neuromuscular irritability (spasms = tetany)
Apnea
Stridor
Cardiomyopathy
Before 2 years of age when a high demand of Ca for rapidly growing bone results in hypocalcemia before rickets

Question 22

Drugs interfering with VD metabolism?

Answer 22

Phenobarbitals

Phenytoin

Question 23

Earliest sign of rickets?

Answer 23

Cranio-tabes pressing over occipital or posterior parietal

Question 24

Harrison sulcus in VD represents ?

Answer 24

Softened ribs attachment to with the diaphragm

Question 25

Healing in rickets occur in?

Can be monitored by?

Answer 25

2-4 weeks

• Lowering of ALP
• increasing VD
• healing on X-ray (but complete reversal may take years)

Question 26

Other feature of hypocalcemia and rickets

Answer 26

Poor growth short stature
Frontal bossing
Delayed closure of anterior fontanelle
Delayed dentition
Hypotonia

Question 27

The most effective single factor in prevention of obesity?

Answer 27

Reduction in time spent on small screens

Question 28

If obese was short look for?

Answer 28

Endogenous cause of the obesity

Hypothyroid or Cushing

Question 29

If obese with learning disability or dysmorphic suspect?

Answer 29

A syndrome
The MC? Prader will syndrome
(Hyperphagia-obesity- poor linear growth-dysmorphic facial feature- hypotonia- undescended testes)

Question 30

Severely obese in less than 3 years?

Answer 30

Suspect leptin deficiency gene defects

Question 31

When is drug treatment considered in obesity?

Answer 31

More than 12 years of age with extreme obesity > 40

Or more than >35 with complications of obesity

Question 32

Most appropriate surgery for obese more than 12 ?

Answer 32

Lap adjustable gastric banding

Question 33

The most common chronic infectious disease of childhood?

Answer 33

Dental carries

Question 34

The main cariogenic organisms?

Answer 34

Strept mutans and sobrinus