PROTEIN ENERGY MALNUTRITION

Question 1

•
(WHO)1 defines malnutrition as “the ____________________ between the ____________________ and ______________ and the ____________________ to ensure growth, maintenance, and specific functions.”

Answer 1

cellular imbalance

supply of nutrients

energy

body’s demand for them

Question 2

The term protein-energy malnutrition (PEM) applies to a group of related disorders that include _________,___________ , and intermediate states of ____________________.

Answer 2

marasmus ; kwashiorkor

marasmus-kwashiorkor

Question 3

Nutrition Components

1)________
2)Macronutrients
•________
•__________
•____________
3)micronutrients

Answer 3

Energy

Fat; protein; carbs

Question 4

Malnutrition can either be acute (______) or chronic (_________)

Acute - ____/_____
Chronic - ______/______

Answer 4

Wasting; stunting

Weight; height

Height; Age

Question 5

Epidemiology
Leading cause of childhood morbidity and mortality.
Age: __________ - ____________ (Period of high energy and caloric requirements, period of weaning and predisposition to viral and bacterial infections).

Answer 5

6 months-5 years

Question 6

Aetiology

Marasmus(Marasmos-withering/wasting)- involves ____________________ and is characterized by ____________ . represents an adaptive response to __________.

Answer 6

inadequate intake of calories

emaciation

starvation.

Question 7

The term kwashiorkor is taken from the Ga language of Ghana and means “the sickness of the _________.“Results from __________________ (with or without ?) reasonable caloric (energy) intake.

Answer 7

weaning

inadequate protein intake

With

Question 8

Weight(%) : 80-60; presence of edema

=???

Answer 8

Kwashiorkor

Question 9

Weight(%) : 80-60; absence of edema

=???

Answer 9

Underweight

Question 10

Weight(%) : <60 ; presence of edema

=???

Answer 10

Marasmic kwashiorkor

Question 11

Weight(%) : <60 ; absence of edema

=???

Answer 11

Marasmus

Question 12

Acute malnutrition:xterized by _________ and _________.

Severe acute malnutrition(SAM):Standard deviation score (SD)based on ____________________ or ____________________
–

Chronic malnutrition: xterized by _____________.

Answer 12

wasting ; edema.

Weight for height or weight for length

stunting.

Question 13

Primary Malnutrition: occurs as a result of only _________________________________ .

Secondary Malnutrition: occurs as a result of __________________________________

Answer 13

calorie and nutrient deficiency

an underlying pathology eg HIV/AIDS,TB etc.

Question 14

Weight for height or weight for length<_____% NCHS/WHO median(____SD) or a _____ MUAC, or there is __________ of the feet signifies SAM

Moderate acute malnutrition: W/H between ——-% and _____% NCHS/WHO median

Answer 14

70

-3; low

Oedema

70; 80

Question 15

Marasmus

History of ____________ /failure to ____________
History of ___________
Significant __________ , loss of ____________ tissue/skin turgor, bones and joints are prominent and the head appears ___________________________ for the body.

Have _____________ look but respond to attention, willing to feed hungrily too(C.f Kwashiokor)

Loss of ____________ fat-ominous sign

Abdomen :may be ________ or __________, visible __________(wasting of abd wall muscles

Answer 15

weight loss; gain weight

diarrhoea; emaciation

subcutaneous

disproportionately large

unhappy look

buccal pad

scaphoid ; distended

peristalsis

Question 16

Severe Acute Malnutrition Marasmus

Severe weight loss and wasting
______ prominent
________ emaciated
Muscle wasting
May have ______ appetite
With correct treatment, good prognosis

Answer 16

Ribs; Limbs

good

Question 17

Clinical features of Kwashiokor

History is insiduous and may occur over weeks(anorexia, vomiting, diarrhea)

Patient appears _________, apathetic, highly irritable, refuses to _______,(marked __________), __________ of subcut tissues and loss of _____________.

Edema is present usually _______________, if there is _______________ look for underlying cause for this.

Answer 17

miserable; feed; anorexia

flabiness; muscle tone

peripheral; significant ascites

Question 18

Clinical features of kwashiorkor

Skin: variable appearance, dermatitis, classical is the ______________ -hyperpigmented, desquamating lesions with raw areas, _______ may be present.
______ pallor, the hair appears ________ and _____________ . Angular stomatitis/cheilosis is common
Hepatomegaly is (common or rare?)

Answer 18

black paint dermatitis; Ulcers

Mild; thin and sparse

Common

Question 19

Other clinical findings in kwashiorkor depends on the presence of complications:
– hypo_______
– Hypo_________
– Infections(_______,________)
– Severe _________

Answer 19

thermia

glycemia

Oral thrush, sepsis

anaemia

Question 20

Admission procedures SCREENING/ TRIAGE
Admit if criteria is fulfilled:

W/H or W/L <______% or
 MUAC < _______ mm with a Length > 65 cm or

 Presence of ____________________

Check for complication and do __________ test.
If patient passes appetite test and no complications present then manage on outpatient basis.
If patient fails appetite test and there are complications then admit.

Answer 20

70

110

bilateral pitting oedema

appetite

Question 21

Appetite test

Conducted using _______ from the packet

It is given to child by the —————

Answer 21

RUTF

caregiver

Question 22

Investigations

Marasmus:There may be __________ derangements except if there is ____________ from __________ or significant ______________ or other infections

Answer 22

no significant

dehydration ; diarrhea

anaemia

Question 23

Investigations for Kwashiokor

Hypo_____________(Total protein, serum albumin levels are low, transferrin levels low)

E/U:Hypo________, (alkalosis or acidosis?) , hypo_____________ ,reduced blood urea.

FBC: ________ , evidence of ________

Serum lipids are ____, exocrine pancreas function is depressed, Lactase deficiency occurs.
Corticosteroids, Growth hormone levels are ______
Pathology: Liver-Fatty infiltration, jejunal biopsy- villus atrophy

Answer 23

proteinemia; kalemia

acidosis; magnesima

Anaemia; sepsis; low

elevated

Question 24

Treatment of PEM

Management is divided into 4 phases:
1.) __________________ phase
2) ___________ and __________________
3.) _________ and ______________
4.) _____________ and ___________ education

Answer 24

1.) Acute Resuscitative phase
2) Stabilization and establishing feeding
3.) Repair and Recuperation
4.) Rehabilitation and nutrition education

Question 25

Acute resuscitative phase

1.) Assess for __________ , __________,and correct appropraitely. If anemia is severe ie PCV< _______% transfuse with __________ slowly
2.) Check __________ and correct __________. Keep patient warm.
3) Check for __________ and correct
4.) Treat infections: Broad spectrum antibiotics
5.) Clean and dress Severe skin lesions

Answer 25

dehydration ; shock ; correct

15% ; packed cells

Temperature ; hypothermia

hypoglycemia

Question 26

Stabilization and establishing feeding

1.) Constant monitoring of infusions and vital signs
2.) Offer oral fluids especially __________ (oral rehydration solution for malnutrition) if there is sig dehydration and pt is able to take orally.
3.) Give small frequent feeds ( ________ is now recommended-starter formular which contains _____ Kcal and ____gprotein/100ml). Introduce as soon as possible and continue for __________ until child is stablilized.
Example of F75 recipe(milk, sugar, cereal flour, vegetable oil, mineral mix and water)

4.) Vitamin A, Folic acid, potassium , zinc and mg supplementation can be given . Avoid _______ therapy in this phase
Treat any eye complications.

Answer 26

Resomal

F75 ; 75 Kcal ; 0.9

2-7

Iron

Question 27

Repair and Recuperation

Establishment of __________ feeding is the key component of this phase

Current recommendation is the introduction of the ______ formular which is used as a ______ formular to ___________.

It contains more calories and protein: _____Kcal and _____g protein per 100ml.Use of Local foods should be encouraged

Answer 27

full mixed feeding

F-100 ; catch up ; rebuild tissues.

100Kcal ; 2.9g

Question 28

Summary of Management of Severe Acute Malnutrition(SAM)

Admit for in patient care with SD score of ____SD, ___________ or any life threatening complication.

Treat/prevent hypothermia and hypoglycemia by __________, _________ and treating infection.
Treat and prevent dehydration using ____________
Correct electrolyte derangement(by giving feeds and Resomal prepared with mineral mix or combined multivitamin mix)

Answer 28

-3; pitting edema

feeding ; keeping warm

ReSomal;