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CNSC Exam > Nutrition and Metabolism > Flashcards

Nutrition and Metabolism Flashcards

1
Q

how long is the small bowel in total

A

400-800 cm (12-20 feet)

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2
Q

less than ___ cm of small bowel without a colon requires TPN

A

< 100 cm

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3
Q

the length of the small bowel correlates to a person’s

A

height

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4
Q

a patient with 100-120 cm of remaining small bowel and an ileostomy may require

A

oral rehydration solution

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5
Q

A 72 year old patient with an end ileostomy is at risk for what deficiency

A

B12

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6
Q

B12 absorption requires

A
  1. normal GI function
  2. adequate HCL production
  3. adequate pepsin in gastric secretions
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7
Q

most of B12 is re absorbed via

A

the enterohepatic circulation via bile salts

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8
Q

patients with these conditions are at risk for decreased B12 absorption

A
  1. Pancreatic insufficiency
  2. impaired HCL production from H2 antagonist meds, PPI’s ,elderly & H Pylori
  3. decreased absorption from ileal resection, stomach resection and chronic malabsorption
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9
Q

patients who have decreased absorption resulting from ileal resection, stomach resection and chronic malabsorption are at risk for this vitamin

A

vitamin B12

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10
Q

vitamin K absorption primarily occurs in the

A

jejunum

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11
Q

thiamine (vitamin B1) is primarily absorbed in the

A

proximal small intestine, mainly the jejunum

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12
Q

vitamin A is primarily absorbed in the

A

upper small intestine/duodenum

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13
Q

this type of viscous fiber leads to gastric distention, which promotes a feeling of fullness, delays gastric emptying and PREVENTs absorption of nutrients in the small intestine

A

soluble fiber

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14
Q

_____ fiber PREVENTS absorption of nutrient in the small intestine

A

soluble

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15
Q

_____ fiber can improve blood glucose control from fiber induced gastric emptying

A

soluble fiber

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16
Q

accumulation of ___ is associated with Wilson’s Disease

A

copper

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17
Q

Copper accumulates in which organ

A

the liver

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18
Q

A genetic mutation of copper metabolism can lead to this disease

A

Wilson’s Disease

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19
Q

Copper relies on _____ for exceretion

A

normal biliary function

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20
Q

the acute phase of injury / infection suppresses the transport of

A

iron

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21
Q

in response to the acute phase of injury or infection you will have _____ serum iron and _____ serum ferritin

A

decreased serum iron (the body sequesters it to decrease the availability of iron for iron dependent microorganisms, decreased free radical production, and decreased oxidative damage to cell membranes & DNA),

increased transferrin to move the Fe around to sequester

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22
Q

the majority of dietary folate is reabsorbed via which mechanism

A

enterohepatic circulation

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23
Q

Dietary folate first converts to ____ by jejunal enzymes then enters into the intestinal cell. It is then further reduced and enters the _________ via ________

A

monoglutamate

portal circulation via, enterohepatic circulation

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24
Q

zinc deficiency, chronic ETOH intake, changes in jejunal pH and impaired bile secretion can limit ___ absorption

A

iron

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25
Q

oncotic pressure, passive diffusion, and plasma hydrostatic pressure govern the movement of ___ between plasma and interstitial spaces

A

fluid

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26
Q

choline supplementation has been tested as a treatment for what

A

hepatic steatosis

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27
Q

choline is needed for ____ transport and metabolism

A

lipid

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28
Q

low plasma choline in LTPN patients is associated with an increase in this level

A

Aminotransferases (liver enzymes)

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29
Q

Currently choline isn’t available for ______ admixes and has NOT been shown to improve ______

A

not available for IV PN

not shown to improve PNAC

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30
Q

the calculation of energy expenditure by analysis of gas exchanged via measurement of oxygen consumption and CO2 production is called

A

Indirect Calorimetry

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31
Q

Indirect calorimetry measures ____ consumption and ____ production

A

O2 consumption and CO2 production

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32
Q

what can decrease the accuracy of an indirect calorimetry study

A
  1. mechanical ventilation with FiO2 >60%, age >60, noisy busy environment, hot or cold room, currently getting routine care, and unstable nutrient intake for the previous 12 hours
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33
Q

Indirect Calorimetry calculates

A

resting energy expenditure (REE) and Respiratory Quotient

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34
Q

IC calculates resting energy expenditure using the abbreviated ____ equation

A

Weir

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35
Q

IC does not measure

A

total energy expenditure, nitrogen balance or heat released from a patient

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36
Q

an RQ of 0.5 indicates

A

mixed substrate, nutrition is appropriate

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37
Q

an RQ < 0.82 indicates

A

under feeding
lipid catabolism
you need to increase energy provision

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38
Q

an RQ >1 indicates

A 
excessive CO2 production
overfeeding
lipogenesis
increased respiratory demand
you need to decrease total calories & decreased carbs
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39
Q

Simple carbohydrates with 1 CHO unit are called

A

monosaccharides

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40
Q

the 3 monosaccharides are

A

glucose, galactose, fructose

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41
Q

What is phosphofructokinase’s role in glycolysis

A

rate limiting enzyme

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42
Q

Phosphofructokinase is a rate limiting enzyme in glycolysis. Glycolysis is the process of breaking down ______ into _____. This occurs when the body is the ____ state when there is a high amount of _____ in the blood and the hormone ___ is elevated. This increases the level of ATP. PFK will then inhibit glycolysis to do what_________

A
  1. glucose to pyruvate
  2. fed state, high amount of blood glucose
  3. insulin
  4. start storing glucose as glycogen
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43
Q

when ATP is low during the starved state and glucagon is present in the blood, phosphofructokinase will be

A

activated

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44
Q

the majority of glycogen is stored in

A

the liver and skeletal muscle

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45
Q

glucose is stored in the liver and skeletal muscle as

A

glycogen

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46
Q

illness and trauma increases the production of counter-regulatory/stress hormones which include

A

epinephrine
glucagon
cortisol
growth hormone

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47
Q

stress hormones work against this hormone

A

insulin

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48
Q

during illness/trauma _____ production by the liver

A

glucose ( about 500 gram)

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49
Q

during illness and stress there is increased ___ breakdown, increased ______ oxidation to provide fuel for increased energy demand

A

protein

fatty

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50
Q

what are the options for selenium measurement

A
  1. plasma glutathione peroxidase
  2. whole blood plasma
  3. erythrocyte levels
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51
Q

if a patient has a decreased intake of chromium, what might happen to their serum blood glucose

A

increases (hyperglycemia)

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52
Q

what are the 2 actions of chromium

A

potentiates the action of insulin

plays role in protein, lipid & glucose metabolism

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53
Q

what are the signs/symptoms of vitamin D toxicity

A

soft tissue calcification, confusion, psychosis, tremor, hypercalcemia, hypercalciuria

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54
Q

when fat is present in the distal ileum, GI transit

A

DECREASES

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55
Q

when fat is present in the distal ileum, GI transit decreases which is known as the __________ which ____gastric emptying

A

ileal break

slows

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56
Q

indigestible plant material that forms in the stomach

A

phytobezoar

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57
Q

what are the treatment options for phytobezoars

A

cola, cellulose, surgical removal

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58
Q

is using papain enzyme recommending for breaking down phytobezoars

A

no, can be associated with PUD and breaks down normal tissues

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59
Q

How should psyllium fiber be delivered via a tube

A
  1. mix 1 TSP with 80mL of water
  2. inject via syringe
  3. then flush with 15mL/ water

GIVE SEPERATELY FROM OTHER MEDS

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60
Q

This RMR energy calculation takes into account body surface area and is effective at estimating nutrition needs in 55% of patients

A

Swinamer Equation

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61
Q

This predictive energy equation uses weight, height, age, sex, trauma and burns

A

Ireton Jones

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62
Q

This predictive energy equation uses weight height and age

A

Mifflin St. Jeor

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63
Q

What are the consequences of underfeeding in the critically ill

A 
increased length of stay
increased complications
increased infections
increased days on abx
increased ventilator days
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64
Q

what are the consequences of overfeeding in the critically ill

A 
hyperglycemia
liver dysfunction
fluid overload
respiratory compromise
increased CO2 production
lipogenesis
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65
Q

when soluble fiber is added to liquid the liquid becomes more ______ there for _______ gastric emptying

A

viscous

delays gastric emptying

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66
Q

avoid _______ fiber in bezoar formation

A

soluble

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67
Q

soluble fiber is fermented in the ______, promotes ____ and ____ absorption and can help improve ___in tube fed patients

A

colon
sodium/water absorption
diarrhea

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68
Q

this type of fiber has a stool softening effect

A

insoluble fiber

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69
Q

insoluble fiber _______ transit time, results in more ______ bowel movements to help with ______

A

decreases (more rapid)
more bowel movements
aids in constipation

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70
Q

The FDA approved ILE that contains 4 oils , differing from 100% soybean oil ILE’s for fat emulsion contain

A

fish oil, olive oil, MCT oil

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71
Q

All FDA available injectable lipid emulsions contain _____ for emulsification, can be given ____ or _____ and provide essential _______

A

egg yolk phospholipids
centrally or peripherally
essential fatty acids

72
Q

what is the 1/2 life of Albumin

A

14-20 days

73
Q

1/2 life of retinol binding protein

A

12 hours

74
Q

1/2 life pre albumin

A

2-3 days

75
Q

1/2 life of transferrin

A

8-10 days

76
Q

fat soluble vitamins require_______ for emulsification to be integrated into ____ and be absorbed into the _____

A

Bile Salts
micelles
enterocyte

77
Q

A patient waiting for a lung transplant has been taking diuretics to control ascites and peripheral edema, what acid-base balance is expected?

A

Pt will lose potassium and chloride via urine via diuretics, bicarbonate will then increase in the body leading to metabolic alkalosis as the ECF water volume contracts

78
Q

hydrogenated hydrophobic carbon atoms with a carboxyl group are known as

A

fatty acids

79
Q

butyric acid is a

A

short chain fatty acid

80
Q

what is the basic structure of a triglyceride

A

1 glycerol back bone with 3 fatty acids attached via an ester bond

81
Q

_____ are derived from cholesterol & are produced by the liver. They help to emulsify triglycerides and form into micelles to hydrolyze for intestinal lipase and esterase to break down fat

A

bile acids

82
Q

short chain fatty acids are made up of __ carbons

A

2

83
Q

glycerol and fatty acids up to ____ carbons are able to be directly absorbed via the mucosal villi without bile acids

A

10 carbons

84
Q

long chain fatty acids have greater than or equal to ____ carbons

A

14

85
Q

long chain fatty acids require _____ for enzymatic digestion

A

bile salts

86
Q

oxidation of fatty acids occurs in cells that

A

have mitochondria

87
Q

cells that have mitochondria generate ATP via _________ which provides the majority of cellular energy

A

oxidative phosphorlyation

88
Q

fatty acids are transported into the ________ ______ then go through _____ where energy is released as ATP

A

mitochondrial membrane

beta oxidation

89
Q

fatty acids provide much more _____ than carbohydrates

A

energy

90
Q

fat is stored in

A

adipocytes

91
Q

linoleic and alpha linolenic acid are known as essential fatty acids becuase

A

they cannot be synthesized by humans and must be obtained by the diet

92
Q

linoleic and alpha linolenic acids are both long chain fatty acids and require _____ to enter into the mitochoondria

A

carnitine

93
Q

a 50 year old male weighs 80 kg, what volume is his intravascular space

A
  1. a 50yoM is about 60% TBW: 0.6 x 80 kg = 48 liters
  2. the intravascular space is in the extracellular fluid
  3. extracellular fluid makes up 1/3 of TBW, so 48 x 0.333 = 16liters.
  4. of the extracellular fluid, the intravascular fluid makes up 25% of that fluid so the answer is 4Liters
94
Q

the more fat a person has the _____ total body water they have

A

less

95
Q

the more muscle a person has, the ____ total body water they have

A

more

96
Q

Sorbitol induced hypokalemia is likely secondary to

A

increased potassium losses from stool

97
Q

what range is considered mild hypercalcemia

A

10.3-11.9

98
Q

the first line of treatment for mild hypercalcemia (10.3-11.9) is

A

hydration and ambulation

99
Q

severe hypercalcemia is considered a serum value of

A

> /= 14 mg/dL

100
Q

when a patient is severely hypercalcemia (>14 mg/dL) what is the treatment option

A

Saline hydration to correct volume depletion
Lasix to enhance renal calcium excretion
ambulation
Hemodialysis if there is renal insufficiency
If 2/2 malignancy: bisphosphonates (but has delayed onset)

101
Q

absorption of large polypeptides, oligopeptides, and free amino acids occurs in this part of the GI system

A

small intestine

102
Q

There is ____ protein digestion in the mouth. ____ is secreted by the stomach of parietal cells in the stomach to denature proteins and coverts inactive ________ to active ________ which hydrolyzes peptide bonds. Peptides then is mixed with chyme when it enters into the _____ where the majority of protein digestion occurs.

A 
minimal
hydrochloric acid
pepsinogen
pepsin
duodenum
103
Q

Nitrogen balance measures 24 hour

A

urine urea nitrogen

104
Q

urea makes up ______% of total urinary nitrogen losses

A

80%

105
Q

urea/nitrogen losses are affected by ____ during hospitalization

A

stress

106
Q

this semi essential amino acid has a role in wound healing and immune function. Don’t supplement in the critically ill as its use is controversial

A

arginine

107
Q

this is a tri-methyl amino acid which is a cofactor for the transition of acetyl-carnitine to transport fatty acids into the mitochondria

A

carnitine

108
Q

The transformation of free long chain fatty acids to acetylcarnitine requires

A

carnitine

109
Q

in what part of the body are essential amino acids oxidized

A

the liver

110
Q

the liver has a key role in ____ metabolism/oxidation which accounts for 57% of amino acids

A

protein metabolism

111
Q

Which of the following is a common effect of enteral fiber on the intestinal tract

A

improves diarrhea

112
Q

what are possible complications of fiber containing enteral formulas

A

flatulence, bloating, abdominal pain

113
Q

Insoluble dietary fiber may help to regulate normal defecation by

A

increasing fecal weight/bulk

114
Q

Insoluble fiber is not _______ by the colon. This creates a ___ which holds water and ____ the stool to ease evacuation

A

degraded/broken down
gel
soften

115
Q

consumption of soluble fiber MAINLY contributes to

A

lower total cholesterol and lower low density lipoprotein cholesterol without changing HDL

116
Q

during extended periods of fasting (starvation) the main source of energy is

A

fatty acid oxidation

117
Q

during starvation, glucose utilization is substantially ____ as well as the hormone ___. _____ then is more concentrated promoting fatty acid oxidation

A

decreased
insulin
glucagon

118
Q

glycogen stores can sustain normal activities in a healthy 70kg man for approximately

A

1 day
100g (liver, ~390 kcal)
300-400g (~1500 kcal)

119
Q

glucose and galactose gain access to enterocytes via

A

sodium glucose transporter 1

120
Q

which water soluble vitamins don’t require sodium co-transporters for absorption

A

B12 (needs intrinsic factor)

Folic Acid

121
Q

Loss of parietal cells after a gastrectomy may lead to a deficiency of

A

Vitamin B12

122
Q

Loss of parietal cells of the stomach which binds to ________ is taken up by receptors in the distal ______

A 
vitamin B12 (cyanocobalamin)
distal ileum
123
Q

Loss of parietal cells, therefor decreased B12 absorption can occur from

A

gastrectomy, pernicious anemia, chronic gastritis, loss of terminal ileum

124
Q

what facilitates the absorption of sodium in the lumen of the small intestine

A

glucose

125
Q

oral rehydration fluid used to treat diarrhea should contain _____ and ______ to enhance sodium and water transportation

A

NaCl and Glucose

126
Q

medium chain triglycerides don’t require formation of micelles or bile salts for absorption because they are

A

water soluble and go directly into portal circulation

127
Q

muscle atrophy that accompanies bowel rest may result from an absence of

A

glutamine

128
Q

_____ is the main metabolic fuel for intestinal cells

A

glutamine

129
Q

An enzyme deficiency commonly seen in Asia, Mediterranean, African American and Native Americans is

A

lactase

130
Q

symptoms of diarrhea, bloating and flatulence after the ingestion of sugar are caused by a deficiency of______. This causes a a shift of water into the intestinal lumen. As colonic bacteria act on remaining _____ this increases osmolarity/diarrhea as well as increased are formed which causes flatulence and bloating

A

brush border oligosacchardiases
oligosacchardies

(undigested parts of carbohydrates: CHO - polysaccharide-oligosaccharide-disaccharide- monosaccharide

131
Q

The majority of fat digestion occurs in the _______ by the enzyme ______. A smaller amount of fat digestion occurs in the ____ by _____ and the _____ by _______

A

Duodenum
Pancreatic lipase
Mouth/Lingual Lipase
Stomach/Gastric Lipase

132
Q

what are the 3 pancreatic enzymes that digest fat in the duodenum/smallintestine

A

pancreatic lipase (triglycerides)
cholesterolesterhydrolase (cholesterol)
phospholipase (phospholipids/fat sol vits)

133
Q

Bile acid’s role in fat digestion is to

A

emulsify

134
Q

A 35 year old patient with a recent history of binge alcohol drinking over the holidays comes in complaining about abdominal pain which radiates to the back. Pt has a history of pancreatitis. The pt reports nausea and a decrease in oral intake for over 1 week, abdominal bloating and oily stools. This patient may benefit from (PN, evaluation for pancreatic exocrine insufficiency, maintain NPO status until symptoms improve, or vitamin supplementation)?

A

He should be evaluated for pancreatic insufficiency as may have fat malabsorption causing his symptoms

135
Q

symptoms of pancreatic exocrine insufficiency are

A

diarrhea, abdominal pain/distention, bloating, cramps, flatulence, weight loss oily stools

136
Q

what is the recommended therapy for pancreatic exocrine insufficiency

A

PERT enzyme therapy

137
Q

what is an amino acid that is conditionally essential and a primary fuel source for enterocytes

A

glutamine

138
Q

what is the most abundant amino acid in the body

A

glutamine

139
Q

in what situations does the body have an increased demand for glutamine

A

sepsis, trauma, exercise

140
Q

decreased _____ levels are associated with mucosal atrophy, impaired immune function and decreased protein syntesis

A

glutamine

141
Q

a patient is getting 95 grams of protein , how much nitrogen is this

A

(16% or /6.25) = 15 grams of Nitrogen

142
Q

A critically ill trauma patient who is 70kg and has a BMI of 23 should get this much protein

A

105 to 144 grams (1.5-2 g/kg)

143
Q

patients on CRRT or a BMI > 30 should get how much protein

A

2-2.5 g/kg/day

144
Q

what protein transports oxygen from the lung to the rest of the body

A

hemoglobin

145
Q

which transport protein contains iron

A

hemoglobin

146
Q

_______ transports lipids, vitamins, minerals, albumin and hemoglobin

A

proteins

147
Q

what 3 organs have the necessary enzymes for gluconeogenesis

A

liver, kidney, small intestines

148
Q

what is the PRIMARY organ responsible for gluconeogenesis

A

liver

149
Q

the range of intake for a particular energy source that is associated with a REDUCED risk of a chronic disease. Includes omega 3/ omega 6 fatty acids and total fat

A

AMDR: acceptable macronutrient distribution range

150
Q

the highest level of intake that is likely to pose NO risk of adverse health effects to almost all individuals in a general population is known as the

A

TUL: Tolerable Upper Limit

151
Q

The average daily nutrient intake level that is estimated to meet 1/2 of the needs of healthy individuals in a particular life stage/gender group is called

A

EAR: estimated average requirement

152
Q

what type of oils are included in commercial enteral formulas to provide a good source of linoleic and alpha linolenic acid

A

soybean, corn, safflower, canola

153
Q

which oils are rich in linoleic acid

A

soybean, safflower, corn

154
Q

which oils are rich in alpha linolenic acid

A

canola, soybean oil

155
Q

The most predominant clinical change seen with essential fatty acid deficiency is

A

a dry scale rash

156
Q

the energy for glucose transport is provided by the active transport of what

A

sodium OUT of the cell

157
Q

____ and sodium are co-transporters. High concentrations of sodium in ____ during digestion increases glucose transport into the cell. Sodium moves into mucosal cells along a concentration gradient and brings glucose along. The active transport of SODIUM _____ of the cell provides the energy for glucose transport. The transport of sodium ___ of the cell maintains a concentration gradient needed for Na to shuttle more glucose into mucosal cells.

A

Glucose and Sodium
Chyme
Out of the cell
Out of the cell

158
Q

A 32 year old female presents with a sunburn like rash. She has been following a low carb, vegetarian diet. She notes recent weight loss, diarrhea and low energy as well as drinking alcohol daily. What deficiency does she most likely have

A

Niacin deficiency with the sunburn like rash and low intake of carbs which are fortified with niacin and meat as she is a vegetarian

159
Q

what are the primary food sources of niacin

A

meat, fish, poultry, fortified breads and cereals

160
Q

what are the primary risk factors associated with niacin deficiency

A 
malabsorptive disorders
vegetarian / low carb diets
individuals with alcoholism
older adults
patients on antitubercular meds such as isoniazid or mercaptopurine
161
Q

The medication Ursodiol facilitates the absorption of

A

fat

162
Q

___ is essential for the digestion of fat

A

bile

163
Q

bile is made up of these components

A 
bile salts
bile pigments
cholesterol
lecithin
electrolytes
alk phos
164
Q

The metabolites that make up bile are (electrolytes)

A

sodium and potassium

165
Q

____ are metabolites of cholesterol which form micelles. They have hydrophilic portions that face out and hydrophobic portions that face toward the enter, where lipids collect. lipids are then transported to the brush border of the intestine and are absorbed

A

bile salts

166
Q

a 72 year old female with impaired renal function was recently prescribed sulfamethoxazole and trimethoprim for a UTI. What electrolyte disorder is most likely to occur

A

hyperkalemia

167
Q

which medications can cause hyperkalemia

A

sulfamethoxazole, trimethoprim, aldactone

168
Q

what are some causes of hyperkalemia

A

too much IV provision
too much intake
IMPAIRED RENAL FUNCTION/ Renal INSUFFICIENCY

169
Q

the first line of therapy of hyperkalemia is

A

calcium gluconate (1-2 mgIV over 10 mins)

170
Q

when should a patient with hyperkalemia be treated with IV calcium gluconate

A

when symptomatic with ECG changes the restore membrane excitability

171
Q

calcium acts as a ____ to cardiac conduction abnormalities seen in severe hyperkalemia

A

antagonist

172
Q

a patient has had an NG tube to suction for the past 48 ours secondary to a post op ileus. What electrolytes will be lost?

A

potassium, sodium or chloride

173
Q

a patient in the ICU has acute, severe diarrhea. Which acid base disorder will most likely be present

A

metabolic acidosis from the loss of bicarb in the stool (normal anion gap)

174
Q

metastatic calcification is a complication of _______

A

hyperphosphatemia

175
Q

the most serious complications of hyperphosphatemia are

A

metastatic/vascular calcification of non skeletal tissues when calcium and phos exceed 55 mg2/dL 2

CNSC Exam (32 decks)

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