Nutrition

Question 1

Measure of skeletal muscle mass in cirrhotics?

Answer 1

1. Mid arm muscle circumference

2. Creatinine-heightindex (must be off steroids)

Question 2

Cholestyramine can cause these vitamin deficiencies? Mechanism?

Answer 2

Folate, vitamin D

Binding and therefore decreased intestinal Absorption

Question 3

Copper deficiency symptoms?

Answer 3

Skin/hair depigmentation
Leukopenia
Microcytic anemia
Neurologic abnormalities

Question 4

IBD patients on TPN with diarrhea or fistula – Possible nutritional deficiency?

Symptoms?

Diagnostic concern?

Answer 4

Zinc deficiency

• Alopecia
• glossitis
• dermatitis on extremities
• loss of dark adaptation

Plasma levels are not accurate because Zinc shifts from serum into liver during acute illness

Question 5

Vitamin E deficiency - signs?

Measure serum levels of?

Answer 5

Hemolytic anemia and neurologic abnormalities (posterior column disease or peripheral neuropathy)

Alpha-tocopherol (Most biologically active form of vitamin E)

Question 6

Water-soluble vitamin That can become deficient in Pancreatic insufficiency? Mechanism?

Time course?

Answer 6

B12 - lack of pancreatic proteases to free cobalamin from R proteins

Years

Question 7

Vitamin A deficiency – early signs? Late signs?

Answer 7

Follicular hyperkeratosis
Night blindness

Conjunctival xerosis (dryness)
Keratomalacia (Degeneration of the cornea)
Blindness

Question 8

Chromium deficiency is seen in which patients?

Symptoms?

Answer 8

Long term TPN

Hyperglycemia, neuropathy/encephalopathy, elevated plasma free fatty acid concentration

Question 9

Signs of copper deficiency?

Answer 9

Dermatologic (skin/hair depigmentation)

Hematologic (leukopenia, microcytic anemia from impaired Fe absorption)

Neurologic disturbances, skeletal abnormalities

Question 10

Selenium deficiency Symptoms?

Answer 10

Cardiomyopathy and myalgias

Question 11

Manganese deficiency?

Manganese toxicity? Usual etiology?

Answer 11

Unknown

Deposition into the basal ganglia causing EPS and seizures

TPN

Question 12

Vitamin a toxicity - signs?

Answer 12

Alopecia
Pseudotumor (headache and nausea)
Conjunctivitis
Dermatitis
Muscle and bone pain
Ataxia
HLD

Question 13

B6 toxicity?

Answer 13

Photosensitivity or peripheral neuropathy

Question 14

Vitamin C toxicity?

Answer 14

Nausea, diarrhea, oxalate nephrolithiasis

Question 15

Vitamin E toxicity?

Answer 15

Hemorrhagic stroke (from reduce levels of vitamin K related pro-coagulants)

Question 16

Vitamin related to HCC? (Deficiency or toxicity?)

Answer 16

Vitamin A deficiency

Question 17

Bile acid resins worsen diarrhea in patients with?

Answer 17

Short bowel syndrome

Question 18

Approved drugs for long-term treatment of obesity? Mechanism?

Answer 18

Orlistat - inhibits pancreatic lipase and reduces fat absorption

Locaserin - 5HT2C agonist. Promotes satiety and regulation of food intake

Phentermine-topiramate - sympathomimetic-AED

Question 19

Medications for short term treatment of obesity? Mechanism?

Answer 19

Phendimetrazine and diethylpropion - noreadrenergic agents

Question 20

Patient status post RYGB who presents with gray hair and memory disturbances – diagnosis? Other symptoms?

Answer 20

B12 deficiency

Mild ataxia and anemia

Question 21

Expected excess weight loss after RYGB? Lap band?

Answer 21

60%; 40%

Question 22

Allergic eosinophilic proctocolitis - seen in? Mechanism? First step?

Answer 22

First 1-2 months of life.

Result of cows milk or soy protein hypersensitivity (eaten by mother, passed in breastmilk to infant)

Elimination of cows milk from maternal diet

Question 23

Eosinophilic gastroenteritis - proposed mechanism?

Answer 23

Cell mediated (not IgE mediated)