Nutrition and Ethics

Question 1

Define diet

Answer 1

The sum of all the foods ingested

Question 2

Define nutrients

Answer 2

Chemical composition of all foods ingested

Question 3

Define food

Answer 3

The individual foods ingested

Question 4

What is the requirement for nutrients defined as ?

Answer 4

The amount of nutrients needed for sustain life and prevent a deficiency

Question 5

What 3 things make up demand ?

Answer 5

Basal requirements
Mechanical work
Substrate turnover

Question 6

What things change demand ?

Answer 6

Temperature
Exercise
Growth
Processing dietary intake

Question 7

Define basal metabolic rate

Answer 7

Requirements needed to stay alive

Question 8

How is basal metabolic rate measured ?

Answer 8

Can be measured directly by direct calorimetry but usually calculated.

Question 9

Define nutritional failure

Answer 9

The failure to meet the nutritional requirements of the body

Question 10

Define malnutiriton

Answer 10

A state of nutrition in which a deficiency causes measurable effects on the body

Question 11

Which cancers is obesity linked to ? (2)

Answer 11

Breast and bowel cancer

Question 12

BMI <20 ?

Answer 12

Underweight

Question 13

BMI <18 ?

Answer 13

Causes physical impairment

Question 14

Define over-nutrition

Answer 14

Intake of nutrients is over supplied

Question 15

Define under-nutrition

Answer 15

Intake of nutrients is under supplied

Question 16

Which scale is used to screen for malnutrition ?

Answer 16

MUST - Malnutrition Universal Screening Tool

Question 17

Describe the 3 steps of MUST

Answer 17

Step 1
BMI
<20 score
<18 score 2

Step 2
Weight loss in the last 3-6 months
5% score 1
10% score 2

Step 3
Has the patient eaten in the last 5 days ?
No score 2

Question 18

What score of the MUST screening tool suggests risk of malnutrition and in need or serious intervention ?

Answer 18

2 or more

Question 19

What score of the MUST screening tool suggests concern and need of supplements ?

Answer 19

1

Question 20

What score of the MUST screening tool suggests need for monitoring ?

Answer 20

0

Question 21

Why are those who are under nourished at risk in hospital ?

Answer 21

Impaired wound healing
Impaired immune system
Reduced muscle strength
Lower mood

Question 22

What are the 3 causes of undernutrition ?

Answer 22

Intestinal failure
Appetite failure
Access failure - stroke, teeth, obstruction

Question 23

Define short bowel syndrome

Answer 23

A group of disorders that are related to poor absorption of nutrients

Question 24

Define ethics

Answer 24

The study of moral standards and how they effect conduct

Question 25

What are the 4 medical ethical principles ?

Answer 25

Justice Autonomy Beneficence Non-Maleasance

Question 26

Define justice

Answer 26

Treating everyone equally

Question 27

Define autonomy

Answer 27

Allowing the individual to decide what is best for them and what they want

Question 28

Define Non-maleficence

Answer 28

Do no harm

Question 29

Define beneficence

Answer 29

Doing good and what's best always. Promoting patient wellbeing

Question 30

What is mental incapacity ?

Answer 30

Being unable to act, make decisions, understand or communicate decisions and remember which ones were made.

Question 31

What is basic care classed as ?

Answer 31

Food and fluids. Basic care is needed to make the individual comfortable.

Question 32

What is treatment classed as ?

Answer 32

In most basic forms anything un-natural e.g. feeding tubes

Question 33

What should you agree on when trialling treatment ?

Answer 33

What is the treatment ? How long ? What is the end point ? What will help you make the decision/targets ?

Question 34

Define somatisation

Answer 34

The manifestation of psychological distress by the presentation of physical symptoms

Question 35

What may cause functional symptoms ?

Answer 35

Gut hormones Gut microbiome Change in diet Psychological factors

Question 36

Which 4 groups of medications can cause GI symptoms ?

Answer 36

Opioids Antidepressants Anticholinergics Cocaine

Question 37

What are the appropriate investigations for functional bowel symptoms ?

Answer 37

Coeliac blood tests/biopsy H.pylori status Endoscopy/colonoscopy USS

Question 38

What is re-feeding syndrome ?

Answer 38

Reintroduction of carbohydrates into the diet when there is reduced insulin secretion. Main sources of energy are fat and proteins.

Question 39

How does re-feeding syndrome present ?

Answer 39

Sharp rise in insulin and lethargy is common. | Arrhythmias and seizures seen.

Question 40

How do you combat re-feeding syndrome ?

Answer 40

Start slowly and increase amount of carbohydrates given. Thiamine should be given 30 minutes beforehand and fluid depletion should be corrected. Potassium, magnesium and phosphate needed.

Question 41

What happens to phosphate levels in re-feeding syndrome ?

Answer 41

Rapidly taken up into cells and used so levels decrease.

Question 42

What is a binge eating disorder ?

Answer 42

A person binges, gains weight and fails to compensate

Question 43

What is Bulimia Nervosa ?

Answer 43

Binges, purges and then restricts. Normal or near normal weight.

Question 44

What is Anorexia Nervosa ?

Answer 44

Significant weight loss due to restriction. Over exercising is common and amenorrhoea seen in young females.

Question 45

Why is an MDT approach in a health care setting beneficial ?

Answer 45

Reduces delays Integrates care Improves outcomes

Question 46

Define precision medicine

Answer 46

Treatments tailored to the individual patient based on their predicted response or risk of disease.

Question 47

Define realistic medicine

Answer 47

Putting the patient at the centre of decisions about their care

Question 48

Which members of the health care team are present at MDT meetings ?

Answer 48

``` Gastroenterologists Oncologist Pathologists Surgeons Clinical nurse specialists Radiologists ```