NUTRITION

Question 1

The most practical and pertinent guide in evaluating nutritional status in children is:

Answer 1

Regular or periodic follow up of weight and height

Question 2

Colostrum is produced over the first 2 days of lactation. The secretion has higher protein and lower fat and lactose than mature human milk. Likewise, it is especially rich in:

Answer 2

IgA

Question 3

The whey-to-casein ratio in mature human milk is about

Answer 3

3:2

Question 4

Foremilk

Answer 4

released at the start of feeding; watery; HIGH LACTOSE AND PROTEIN

Question 5

Hindmilk

Answer 5

released as feeding progresses until towards the end of feeding; creamy; HIGH FAT (5X MORE THAN FOREMILK)

Question 6

FIRST 0-7 DAYS

• 37-84 mL/day; D1-2 of life
• Watery (>80% water)
• protein-rich
• High in Ig/protective factors: lactoferrin, lysozyme
• Na, vit A/K & growth factors
• Low levels: fat & carbohydrates

Answer 6

COLOSTRUM

Question 7

• Between colostrum & mature milk
• Rising levels of macronutrients

Answer 7

TRANSITIONAL MILK

Question 8

• D 10-14 of life
• Colostrum content + high fat & lactose

Answer 8

MATURE MILK

Question 9

o produced when breastfeeding frequency decreases

o reverts to being more like colostrum

Answer 9

INVOLUTIONARY MILK

Question 10

BREAST MILK COMPOSITION

Answer 10

• casein to whey ratio - low
  
  • 10:90 in early milk
  • 40:60 in mature milk
  • 50:50 in late lactation
• fat globules bound by membranes rich in:
  
  • phospholipids – cell growth & brain development
  • cholesterol – facilitates myelination of the CNS

Question 11

Breast milk has MORE compared to Formula milk except

Answer 11

§ Iron

§ Vit D

§ Vit K

Question 12

Definitive test for GERD

Answer 12

esophageal pH probe

•

Question 13

management for intractable GERD, refractory esophagitis & strictures, with morbidities from chronic pulmonary disease (recurrence rate of 14%)

Answer 13

Fundoplication

Question 14

Which of the following is an absolute contraindication to breastfeeding?

Answer 14

nfant with galactosemia

Question 15

CONTRAINDICATIONS TO BREASTFEEDING

Answer 15

• Galactosemia
• Septicemia
• Active TB
• Breast Cancer
• Malaria
• Substance Abuse
• Severe neurosis or Psychosis
• HIV

Question 16

Micronutrient deficiency that presents with Vesiculobullous, eczematous, dry scaly or psoriasiform lesions symmetric perioral, sacral, and perianal areas; Chronic diarrhea, Stomatitis, Glossitis, Irritability, superinfection

Answer 16

Zinc

Question 17

Generalized scaly dermatitis; Alopecia, Thrombocytopenia, Failure to thrive

Answer 17

Essential Fatty Acids deficiency

Question 18

Edema, erythema and burning of sun exposed skin on the face neck hands on butterfly distribution dermatitis around the neck; Diarrhea, dementia

Answer 18

Niacin (Pellagra) / Vit B3

Question 19

Alopecia with neurological symptoms

Answer 19

Biotin / Vit B7

Question 20

This is seen in what condition?

Answer 20

Vitamin A deficiency

“BItot SPot”

Question 21

Disease of growing bone which occurs in children only before fusion of the epiphyses

Answer 21

Rickets

Question 22

“rachitic rosary” and “Harrison groove” are seen in what disorder?

Answer 22

Rickets

* Widening of the costochondral junctions leads to “rachitic rosary”

* “Harrison groove” is a horizontal depression along the lower anterior chest due to pulling of the softened ribs by the diaphragm during inspiration

Question 23

This is seen in what disease?

Answer 23

Rickets

* Windswept deformity (valgus deformity of 1 leg with varus deformity of the other leg)

Question 24

Treatment of Rickets

Answer 24

Vitamin D 300,000-600,000 IU orally or IM as 2-4 doses over 1 day (Stoss therapy)

• Either strategy should be followed by daily Vit D intake of 400 IU/day as a multivitamin
• Adequate dietary calcium & phosphorus

Question 26

Angular cheilosis (perleche) and Glossitis (magenta tongue) are associated with?

Answer 26

Vit B2, Scurvy and Zinc deficiency

Question 27

This is seen in what deficiency state?

Answer 27

**Vit B3 deficiency** " Casal Necklace "

Question 28

Mothers who have been long term users of high estrogencontaining contraceptives may have lower levels of _____ and need supplements of 20mg/day

Answer 28

Vit B6

Question 29

**Microcytic anemia**, cheilosis, glossitis, dermatitis

Answer 29

Vit B6 deficiency

Question 30

This is seen in what deficiency state?

Answer 30

Vitamin C deficiency (Scurvy) * **“scorbutic rosary” at the costochondral junction & depression of the sternum** * **Angulation of the scorbutic beads is sharper** than the rachitic rosary

Question 31

* Bluish, purple spongy swellings of the mucous membranes esp. over the upper incisors * Other symptoms: swollen joints, purpura and ecchymoses, poor wound & fracture healing * perifollicular hemorrhages, hyperkeratosis of hair follicles, **“corkscrew hair”** * X ray changes: **distal ends of long bones with a ground-glass appearance**

Answer 31

Scurvy

Question 32

Most micronutrients in breastmilk are not affected by maternal diet/status. _____ and _____ are affected by maternal status.

Answer 32

Vitamin D and Iodine

Question 33

full-term neonates are born with sufficient stores of ____ and ____ that are enough for the first 6 months of life.

Answer 33

Iron and Zinc

Question 34

Bowlegs or knock knees Caput quadratum, Periosteal osteoid Craniotabes Ping pong ball sensation Rachitic rosary, Pigeon chest Harrison groove

Answer 34

Vit D Deficiency

Question 35

“**White line”** on end of shafts, **Scorbutic rosary/beads**

Answer 35

Vit C deficiency

Question 36

Pellagra, Casal necklace, Pellagrous glove and boots, Glove and boots lesion

Answer 36

Niacin (Vit B3) deficiency

Question 37

Perleche

Answer 37

Vir B2 deficiency

Question 38

Bitot spots, Xerosis conjunctivae, Xerosis cornea

Answer 38

Vit A Deficiency

Question 39

Hyperostosis, Absence of metaphyseal changes

Answer 39

Vit A Intoxication

Question 40

A deficiency of this trace element is associated with skin ulcers, reduced immune response and hypogonadal dwarfism:

Answer 40

Zinc

Question 41

Irritability, pruritus, painful extremities, with brawny swelling, coarse hair, dry skin, seborrhea and increased intracranial pressure is seen in

Answer 41

Hypervitaminosis A

Question 42

In a Southwestern town in Mindanao, children are fed mostly with **corn** as staple. The most common vitamin deficiency encountered in these children is:

Answer 42

Niacin

Question 43

In children with malnutrition, the most seriously compromised immunologic function is:

Answer 43

Antibody production \* One of the macronutrients severely affected in malnutrition are proteins (think Kwashiorkor). Therefore, problem in proteins → problem in antibodies.

Question 44

anthropometrics useful to assess Wasting and **Acute malnutrition**

Answer 44

Weight for height

Question 45

§ Measures linear growth § Represents cumulative impact of adverse events

Answer 45

Height for age (length for age if \<2)

Question 46

For malnutrition, the term we are looking for is WASTING. Only three parameters can be used depending on age of patient:

Answer 46

**Weight for length/height, MUAC, BMI**

Question 47

Differentiate kwashiorkor and marasmus

Answer 47

Question 48

Severe wasting is extreme thinness diagnosed by

Answer 48

**weight-forlength (or height) below −3 SD** of the WHO Child Growth Standards

Question 49

children ages **6-59 mos**, a mid-upper arm circumference ____ also denotes extreme thinness

Answer 49

\<115mm

Question 50

Hallmark of REFEEDING SYNDROME

Answer 50

severe hypophosphatemia

Question 51

BMI PERCENTILE FOR AGE

Answer 51

Question 52

* Rare complication of **extreme exogenous obesity** in which patients have **severe cardiorespiratory distress with alveolar hypoventilation** & a decrease in pulmonary, tidal & expiratory reserve volumes * Polycythemia, hypoxemia, cyanosis, cardiac enlargement, CHF, somnolence * Weight reduction as rapidly as possible

Answer 52

PICKWICKIAN SYNDROME

Question 53

Treatment goal for obesity

Answer 53

Weight maintenance