Nutrition in medicine

Question 1

Define malnutrition

Answer 1

Deficiences, excesses or imbalances in bodies macro and micronutrients

Question 2

Define undernutrition

Answer 2

Form of malnutrition resulting from reduced supply of food or inability to digest, assimilate or utilise necessary nutrients

Question 3

What % of the following types of patients are undernourished

a) on admission
b) in patients
c) out patients

Answer 3

a) 28-40%
b) 66%
c) 45-100%

Question 4

Which groups are most vulnerable to under nutrition in the UK

Answer 4

Chronic diseases
Elderly
Recently discharged
Low income
Socially isolated

Question 5

Name 4 consequences of under-nutrition in the community

Answer 5

Falls, depression, increased infection risk, dependency

Question 6

Name 5 consequences of under-nutrition in the hospital

Answer 6

Increased morbitity
Increased length of stay
Increased dependency
Increased mortality
Increased costs of care

Question 7

Name some causes of disease related under nutrition that relate to reduced nutritional intake

Answer 7

• Anorexia
• Side effects of treatment
• Pain
• Dysphagia
• Physical disablity
• Nil by mouth

Question 8

Name some causes of disease related under nutrition that relates to increased nutritional losses

Answer 8

Malabsorption

Wound exudate/ burns

Question 9

Name some causes of disease related under nutrition that relates to increased nutritional requirement

Answer 9

Inflammation/ infection
Pyrexia
Tissue healing
Metabolic effects

Question 10

How long does it take undernourished catabolic patients to reach death

Answer 10

5 weeks

Question 11

How long does it take undernourished patients in an otherwise normal metabolic state to reach death

Answer 11

10 weeks

Question 12

Describe the changes that occur during undernutrition that lead to nitrogen death

Answer 12

• Decreased muscle mass
• Decreased visceral proteins
• Impaired immune response
• Impaired wound healing/ response to truama
• Multiple organ failure

Question 13

Describe the changes that occur during undernutrition that lead to energy death

Answer 13

-Lack of initiative
- Bedridden
- Apathy
- Depression
- Personality changes
- Total apathy
0 Complete exhaustion

Question 14

At what % of original body weight does nitrogen death usually occur

Answer 14

60

Question 15

What screening tool is used to detect malnutrition

Answer 15

MUST (malnutrition universal screening tool)

Question 16

What 2 areas does subjective global assesment

Answer 16

History

Physical

Question 17

What needs to be examined when taking history as part of subjective glocal assesment

Answer 17

Weight changes
Appetite
Taste changes
Diet history
GI symptoms

Question 18

What needs to be physically examined as part of subjective global assessment

Answer 18

Muscle wasting
Fat
Ascites
Oedema

Question 19

What nutritional investigations can be done in the lab to assess nutrion

Answer 19

Anaemia
Plasma proteins
Vit. and mineral
Immune response

Question 20

What makes up total energy expenditure (TEE)

Answer 20

Basal metabolic rate
Thermic effect of food
Physical activity
Stress factors

Question 21

How is BMR measured

Answer 21

Subject lying down in comfortably heated room not digesting food

Question 22

What % of TEE does BMR account for

Answer 22

60-70

Question 23

Define basic metabolic rate

Answer 23

Energy used in involuntary msucle contraction and cellular action

Question 24

When is BMR high

Answer 24

Young people
Tall, thin people
Pregnant women
Stress

Question 25

What makes up nutriton support team

Answer 25

Dieticians
Doctor
Nurse
Pharmacist

Question 26

What are some indications for gastrostomy feeding

Answer 26

Reduced conciousness
Unsafe swallow
Pre head and neck cancer
Special situations liek cystic fibrosis

Question 27

What are some indications for parenteral nutritino

Answer 27

Prolonged postoperative ileus
Intestinal obstruction
Short bowel
Small bowel fistula
Acute pancreatitis
GI motility disorders