05a: Nutrition/Vitamins

Question 1

List the various forms of Vitamin A

Answer 1

1. Retinol (transport form)
2. Retinol ester (storage)
3. Retinal (visual pigment)
4. Retinoic acid (oxidized)

Question 2

Functions of Vit A

Answer 2

1. Maintain normal vision (in reduced light)
2. Differentiation of mucus-secreting epithelium (an other cells; ex: APML, acne)
3. Enhancing immunity to infections (increase T-cells, esp CD4)

Question 3

Vit A deficiency effects which systems?

Answer 3

1. Vision (night blindness)
2. Pulm (infections)
3. Renal (stones)
4. Skin (follicular/papular dermatitis and dry skin)
5. Immunity (infections)

Question 4

Acute (X) toxicity has been associated with eating liver of polar bears, sharks, whales. What are symptoms?

Answer 4

X = vit A

HA, dizziness, vomiting, stupor, blurry vision (pseudotumor cerebri)

Question 5

Vit (X) toxicity causes extremely high risk for spontaneous abortions/birth defects.

Answer 5

X = A

Question 6

Chronic vit A toxicity Sx:

Answer 6

Fatigue, skin changes, alopecia, arthralgia, sore throat

Question 7

T/F: Vit A toxicity more common than Vit C toxicity.

Answer 7

True - lipid soluble vit toxicity more common than water soluble due to fat accumulation

Question 8

Which groups/patients are at risk for lipid-soluble vitamin deficiency?

Answer 8

Elderly, alcoholics, liver disease pts

Question 9

Vit C crucial in multiple processes, most notably (X).

Answer 9

X = collagen synthesis (hydroxylation of pro-collagen)

Question 10

T/F: Vit C acquired entirely by diet.

Answer 10

True - not synthesized endogenously

Question 11

Vit (X) facilitates Fe absorption by keeping it in (ox/red) state.

Answer 11

X = C

Red (Fe 2+)

Question 12

Vit C deficiency commonly seen in which groups of people?

Answer 12

1. Elderly
2. Chronic alcoholics
3. Dialysis pts
4. Infants on formula

Question 13

Vit C deficiency Sx:

Answer 13

1. Hemorrhage (gum, skin/petechiae, joints)
2. Disordered calcification/osteoid matrix formation
3. Impaired wound healing

Question 14

Vit C toxicity Sx:

Answer 14

N/V, diarrhea, fatigue, sleep issues

Question 15

When assessing nutritional status, you realize your patient has lost weight (muscle and fat). What’s the next sign you check for?

Answer 15

Inflammation

Question 16

When assessing nutritional status, you realize your patient has lost weight (muscle and fat). There are no signs of inflammation. What is the likely cause of malnutrition?

Answer 16

starvation-related malnutrition

Question 17

When assessing nutritional status, you realize your patient has lost weight (muscle and fat). There is mild/moderate inflammation. What is the likely cause of malnutrition?

Answer 17

Chronic disease (organ failure, pancreatic cancer, Rheumatoid arthritis)

Question 18

When assessing nutritional status, you realize your patient has lost weight (muscle and fat). There is severe inflammation. What is the likely cause of malnutrition?

Answer 18

Acute disease/injury-related (major infection, burns, trauma, head injury)

Question 19

Why does Refeeding Syndrome occur?

Answer 19

Chronic starvation/malnutrition followed by refeeding causes high insulin secretion and high glucose/electrolyte uptake in cells (electrolyte imbalance)

Question 20

Main electrolyte imbalances in Refeeding Syndrome:

Answer 20

1. Hypophosphatemia***
2. Hypokalemia
3. Hypomagnesemia

Question 21

Potential life-threatening complications of Refeeding Syndrome

Answer 21

1. Cardiac dysfunction
2. Rhabdo
3. Hemolysis
4. Resp failure

Question 22

What are the internationally validated guidelines for Rx of Refeeding Syndrome?

Answer 22

There are none (no RCTs)

Replete electrolytes/thiamine replacement, restrict caloric intake

Question 23

List some complications of jejunoileal bypass involving other organ systems

Answer 23

1. Renal failure (oxalate storm)

2. Liver failure (bac overgrowth in blind gut)

Question 24

T/F: Up to 100% of patients that undergo jejunoileal bypass have hepatic abnormalities.

Answer 24

True - 40% have liver failure and 10% mortality from this

Question 25

Which mineral deficiency is relatively common in bariatric surgery?

Answer 25

Zn

Question 26

Pt undergoes bariatric surg and presents a year later with some hair loss. This could be due to (X), so you look for which other key symptoms?

Answer 26

X = Zn deficiency 1. Alopecia 2. Delayed wound healing 3. Hypogonadism

Question 27

Pt being treated for Zn deficiency develops anemia, numbness/tingling and ataxia. What is the likely cause?

Answer 27

Cu deficiency (ALWAYS CHECK Zn and Cu at same time! absorbed together)

Question 28

Bariatric surg patient being treated for Zn deficiency must also (take/avoid):

Answer 28

Take Cu supplements (1 mg Cu for each 8-15 mg Zn)

Question 29

T/F: Sleeve Gastrectomy is a purely malabsorptive procedure.

Answer 29

False - purely restrictive (decrease stomach size) so less nutrient deficiencies

Question 30

Bariatric surg pt presents with ataxia, confusion, and double vision. What's the likely diagnosis?

Answer 30

Thiamine deficiency! (triad: ophthalmoplegia, ataxia, altered mental status)

Question 31

Gastric bypass is a (restrictive/malabsorptive) procedure that commonly causes (X) deficiency.

Answer 31

Both | X = Fe

Question 32

Gold standard bariatric procedure up till now

Answer 32

Roux en Y bypass

Question 33

Patients with mild/moderate hypoglycemia have blood glucose around (X) mg/dL and which Sx?

Answer 33

X = 70 Sweating, trembling, difficulty concentrating, light-headed, lack of coordination

Question 34

Patients with mild/moderate hypoglycemia should be treated with:

Answer 34

Self treat (rule of 15) 15g glucose/snack Recheck glucose after 15 min

Question 35

DM I patient feels hypoglycemic, so he goes to the fridge to pour a glass of milk. Would skim or whole milk be the better option?

Answer 35

Skim (or lowfat) - fat delays absorption of CHO

Question 36

Self-treating hypoglycemia: (fruit juice/doughnuts/cheese/raisins/chips) would be good options for quick-acting CHOs

Answer 36

Fruit juice, Raisins (the rest are high in fat)

Question 37

Severe hypoglycemia is usually characterized by:

Answer 37

Inability to self-treat (mental status change)

Question 38

Your friend with DM I becomes very lethargic and you are concerned he's hypoglycemic. What would you grab right away if he can swallow?

Answer 38

Glucose gel, honey, juice

Question 39

Your friend with DM I becomes very lethargic and you are concerned he's hypoglycemic. What would you grab right away if he can't swallow?

Answer 39

Glucagon injection (from kit)

Question 40

Atkin's diet is (low/high) (X) diet with which adverse effects?

Answer 40

Low X = CHO (induction period only 20g CHO per day!) Restrictive, increase CV disease risk (no restrictions on intake of calories, protein, or fat (except no trans fats))

Question 41

T/F: The DASH diet has no known cons

Answer 41

True

Question 42

The DASH diet recommends (X) servings of fruit and (Y) servings of vegetables per day.

Answer 42

X = Y = 4-5

Question 43

The (X) Diet is a vegetarian diet designed to provide calories in the following ratio: 10% (CHO/fat/protein), 20% (CHO/fat/protein), 70% (CHO/fat/protein). What are the caloric restrictions?

Answer 43

X = Ornish Fat; protein; CHO No caloric restrictions

Question 44

T/F: The Ornish diet can reverse heart disease

Answer 44

True - if followed strictly

Question 45

(X) Diet provides emphasis on exercise and stress reduction

Answer 45

X = Ornish

Question 46

Average consumption of American population: (X)% fat, (Y)% CHO, (Z)% protein.

Answer 46

``` X = 45 Y = 30 Z = 25 ```

Question 47

Cons of vegetarian diet include potentially inadequate (X) intake

Answer 47

X = vit B12 and omega-3 FA

Question 48

Vegetarian diet can reduce risk of:

Answer 48

1. CV disease, HT, DM II 2. Certain cancers 3. RA, gallstones, kidney disease

Question 49

T/F: The paleo diet is high in Na

Answer 49

False - low in Na, excludes salt from diet

Question 50

Which major food groups are excluded in Paleo diet?

Answer 50

Grains and dairy

Question 51

T/F: Paleo diet is high in fat intake

Answer 51

True

Question 52

Gluten found in:

Answer 52

Barley, wheat, rye

Question 53

Many gluten-free food is also not enriched with (X), which can lead to deficiency in these if gluten-free diet is followed

Answer 53

X = Fe, fiber, folate

Question 54

Low CHO v low fat diet: which had greater weight loss at 12 mo?

Answer 54

Both had similar weight loss

Question 55

Low CHO v low fat diet: which was better with regard to dyslipidemia and glycemic control?

Answer 55

Low CHO

Question 56

(X) are orexigenic neurons located in (Y) part of brain. They (increase/decrease) satiety and (increase/decrease) food intake.

Answer 56

``` X = NPY (neuropeptide Y) Y = arcuate nucleus (hypothalamus) ``` Decrease; increase

Question 57

(X) are anorexigenic neurons located in (Y) part of brain. They (increase/decrease) satiety and (increase/decrease) food intake.

Answer 57

``` X = POMC Y = arcuate nucleus (hypothalamus) ``` Increase; decrease