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My Neo Board Quickfacts > FEN/Renal > Flashcards

FEN/Renal Flashcards

1
Q

photophobia
conjuctivitis
failure to thrive
generalized scaling
abnormal epiphyseal bone formation
abnormal tooth enamel

A

Vitamin A (Retinol)

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2
Q

Vitamin important for pulmonary epithelial growth and cell differentiation

A

Vitamin A
(Retinol)

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3
Q

What deficiency:
fatigue
irritability
constipation
cardiac failure

A

B1 - Thiamine

note: Beriberi = thiamine deficiency

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4
Q

deficiency a/w:
- pyruvate dehydrogenase complex deficiency
- maple syrup urine disease

A

B1 - Thiamine

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5
Q

Wet vs Dry Beriberi

A

*B1 (Thiamine) deficiency

Wet:
- dilated cardiomyopathy
- edema

Dry
- peripheral neuopathy
- muscle wasting

?fatigue, irritability, consitipation

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6
Q

Deficiency:
failure to thrive
photophobia
blurred vision
dermatitis
mucositis

A

B2 - riboflavin

*blurred vision/photobia from corneal vascularization?

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7
Q

a/w glutaric acuduria type 1

A

B2 (riboflavin) deficiency

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8
Q

Triad (what deficiency):
cheilosis
stomatitis/glossitis
NORMOcytic anemia

A

B2 - riboflavin

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9
Q

dermatitis
mucositis
hypo chromic anemia
sideroblastic anemia
+/- seizures

A

B6 - pyridoxine

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10
Q

alopecia
dermatitis
scaling
seborrhea

A

B7 - Biotin

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11
Q

a/w
beta-methylcrrtnyl glycinuria
propionic acidema
pyruvate dehydrogenase complex deficiency

A

B7 - Biotin

(also w/ biotinidase deficiency)

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12
Q

MACROcytic anemia
hypersegmented neutrophils

(2 answers)

A

B12 - Cobalamin
B9 - Folate

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13
Q

A/w pyruvate dehydrogenase complex deficiency

A

B1 - Thiamine
B7 - Biotin

(deficiency)

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14
Q

poor wound healing
bleeding gums

A

Vitamin C (ascorbic acid)

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15
Q

A/w transient tyroninemia

A

Vit C deficiency

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16
Q

Rickets
Failure to thrive
Possible tetany

A

Vitamin D

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17
Q

hemolysis
anemia
reticulocytosis
thrombocytOSIS
acanthocytois
neuro sequelae

A

Vit E

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18
Q

failure to thrive
alopecia
diarrhea
peri-anal dermatitis
rash - crusted, erythematous (face/extrem)
nail hypoplasia/dysplasia
low serum alk phos

A

zinc

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19
Q

acrodermatitis enteropathica

A

causes zinc deficiency

Autosomal RECessive
defective zinc uptake in duodenum and jejunum
abnormality in ZIP4 (zink transporter protein)

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20
Q

Important component in carbonic anhydrase and carboxypeptidase

A

zinc

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21
Q

calories in dextrose per gram

A

3.4 kcal/g

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22
Q

Preserved during pasteurization process

A

oligosaccharides
Vit A, D, E
lactose
Long chain polyunsaturated fatty acids
epidermal growth factor
IgA and IgG

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23
Q

destroyed during pasteurization process

A

lymphocytes
alk phos
cytokines
some growth factors
lipoprotein
some lipases
IgM

*lactoferrin reduced ~50%
* lysozyme reduced ~25%

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24
Q

RTA Type 1

Etiology
Urine pH
Serum K

A

Distal tubule - decreased H+ secretion

Urine pH high (>6.5)
Serum K low

*hypercalciuria/nephrocalcinosis - STONES

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25
Q

RTA Type 2

Etiology
Urine pH
Serum K

A

Proximal tubule - decreased bicarb resorption

Urine pH more acidic < 5.5
(H+ secretion/ammonium production enhanced)
Serum K low-normal

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26
Q

RTA Type 4

Etiology
Urine pH
Serum K
Urine Calcium

A

Distal tubule - affects Na/K vs H+ exchange
(like hypoaldosteroneism/ spironolactone)

Urine pH - normal/low
Serum K = HIGH

*can be caused by obstructive uropathy

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27
Q

Fanconi = similar to which RTA

A

Type 2

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28
Q

Acetazolamide works like which RTA

A

Type 2

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29
Q

RTA a/w renal stones

A

Type 1

(decreased citrate excretion and hypercalicuria)

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30
Q

amphoterocin can cause RTA _____

A

Type 1

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31
Q

aldosterone works on what channels

A

Na/K on principal cells (K to urine, Na resorbed)
EnAC on apical side

(K/H+ on intercalated cell - K resorbed but still
net K excretion)

(also ENaC channels on principal cells)

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32
Q

lactase levels reach adult levels by ____ wks gestation

A

36

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33
Q

intestinal disacharidases* (except lactase) reach adult levels by ____ wks gestation

*sucrase, maltase, isomaltase

A

28

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34
Q

pancreatic amylase present at ____ gestation

A

22

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35
Q

why is carbohydrate digestion/absorption adequate in neonate

A

colonic salvage pathway
adequate concentrations of glucosidases/disacharidases
normal glucoamylases concentration

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36
Q

preterm formula has more whey or more casein

A

whey (60:40)

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37
Q

colostrum has more whey or more casein

A

whey (80:20)

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38
Q

mature milk has more why or more casein

A

whey (55:45)

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39
Q

at what age (corrected) do ECF and ICF ~equal

A

3 months

(ECF is coming down and ICF is coming up)

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40
Q

TBW % (ECF %) of body weight
24 wks
32 wks
40 wks

A

24 wks 90% (65%)
32 wks 83% (53%)
40 wks 80% (45%)

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41
Q

RTA a/w hearing loss (recessive form)

A

type 1 RTA

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42
Q

kidney development begins with _____ at ____ weeks
nephrogenesis begins at ____ weeks
first glomeruli develop ____ weeks
nephrogenesis complete by ____

A

pronephros 2-3wks
nephrogenesis (metanephros) 5th wk
glomeruli 9 weeks
complete by 34-36 weeks

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43
Q

kidney embryology stages

A

pronephros - transient disappears by 4th wk

meSOnephros - ureteric bud; absorbed into urogenital sinus (vas defers, seminal vesicles)

meTAnephros - definitieve kidney; appears 5th wk; continues dev through 32-36wk

ureteric bud = collecting ducts, pelvises/calyces, ureter

metanephric mesenchyme (+ interaction with ureteric bud) = glomerulus through DCT

44
Q

urine production begins _____

A

10-12 weeks

45
Q

urine production at 20 wks and 40 wks gestation

A

20 wks: 5 ml/hr
40 wks: 50 ml/hr

*90% or amniotic fluid urine by 20 wks

46
Q

in utero, fetal kidneys receive ____% cardiac output

infant kidney’s receive ___% of cardiac output

A

fetal: 25%

infant: 10 % (<5% during birth)

47
Q

endothelin = renal vaso__________
produced by________
stimulated by ________

A

vasoCONSTRICTOR

produced by RENAL VASCULAR ENDOTHELIAL CELLS

stimulated by ANGIOTENSIN II, BRADYKININ, EPINEPHRINE, or STRESS

48
Q

fetus begins to accumulate copper stores____ trimester (where stored)

A

third (50-60% stored in liver)

born at least 28wks = enough stores for ~2 mo

49
Q

Free water deficit calculation

A

4ml H20 per kg
for every 1 mEq Na above 145 (or desired goal)

i.e. = 4* wt (kg) * [desired Na change (mEq/l)]

OR

term: 0.6 x wt x (current-desired /desired)
preterm: 0.7 x wt (current - desired/ desired)

50
Q

Most variable component of breast milk (dependent of gestational age and maternal diet)

A

triglycerides

51
Q

Protein = ______% of calories for + nitrogen balance

Minimal goal (g/d)
VLBW
preterm
term

A

7-15%

VLBW: 4 g/kg/d
preterm: 2.5-3.5 g/kg/day
term: 2.0-2.5 g/kg/day

52
Q

kcal expenditure in neonate:

resting metabolic rate

A

40-60kcal/kg/d

53
Q

Energy expenditures from most to least; in kcal/kg/day

A

Enterally fed:
40-60 kcal/kg/d- resting metabolic rate
20-30 kcal/kg/d- storage
15 kcal/kg/d- synthesis/thermic effect of feeding
15 kcal/kg/d- excretion
0-5 kcal/kg/d- activity
0-5 kcal/kg/d- cold stress

90-120kcal/kg/day

54
Q

(location of absorption)

protein
fat (some)
CHO
Fe
Calcium
Mag

A

Jejunum

*Fe mainly in duodenum but some in proximal jejunum

55
Q

(location of absorption)

B12
bile salts
fats
fat-soluble vitamins (ADEK)
Zinc

A

Ileum

*also releases hormones

*can compensate some functions of the jejunum

56
Q

Cause of poor growth in patients with RTA

A

direct effect of acidosis on GH (decreased)

additionally - poor feeding i/s/o acidosis

57
Q

infant’s reduced ability to concentrate urine is related to:

A
  • tubule insensitivity to vasopressin/ADH
  • low serum urea
  • reduced NA absorption in thick ascending loop –> low medullary osmolality
  • short LOH
58
Q

permeability of glomerlular basement membrane _______ with GA

A

increases

(more permeable with increasing GA)

59
Q
A
60
Q

Calories for:
dextrose
protein
fat

A

dextrose 3.4
protein 4
fat 9

61
Q

hematuria, thrombocytopenia, renal failure

A

renal vein thrombosis

(though most infantas do not present with this full constellation of symptoms)

62
Q

NON-essential AAs

A

Alanine
Asparagine
Aspartate
GlutamATE
Serine
Homocysteine (?)

63
Q

AA that are glucose precursors

A

Alanine*
Glycine*
Glutamate*
Aspartate
Cysteine
Proline

(both glucogenic and ketogenic):
Tyrosine
Isoleucine
Phenylalanine
Tryptophan

64
Q

AA precursor to NO

A

Arginine

65
Q

Highest AA concentration in human milk

A

GlutamINE

66
Q

Ratio Ca: Phos

A

Ca: Phos 1.3 : 1

Calcium: 50-60mg/dL
Phos: 40-45 mg/dL

*gives ~60-70% of that deposited by fetus during 3rd trimester

67
Q

ADH - V1 vs V2

A

V1:
peripheral vasoconstriction
glycogenolysis
platelet aggregation
vascular smooth muscle hypertrophy

V2:
increase water perm of collecting ducts by inducing aquaphorins

68
Q

When is ADH present in fetus

A

11 weeks

  • aids in regulating proliferation and morphogenesis of target cells in the brain, pituitary, kidney, and liver
69
Q

ADH - made and stored

A

made: hypothalamus
(supraoptic and paventricular nuclei)

stored: POSTERIOR pituitary

70
Q

Thiazide diuretics mech/location

A

Distal convoluted tubule (early distal)

block Na/Cl co-transporter

*only ~5% of Na resabsorption happens in distal tubule, so effect is limited

71
Q

Thiazide increases urinary losses of:

A

Na
Cl
K
Mg
Bicarb
Phos

72
Q

Thiazide diuretics can lead to what metabolic derangement

A

hypochloremic metabolic ALKalosis*

hyperuricemia

*despite increased loss of bicarb

73
Q

Unlike loop diuretics, Thiazides lead to DECREASE in _____ excretion

A

Calcium

74
Q

Loop diuretics location and mech

A

Thick ascending LOH

Inhibit Na+/2Cl-/K + co-trasporter

75
Q

Essential fatty acids

A

alpha-linolenic (omega 3)
Linoleic (omega 6)

76
Q

2 most prevalent FAs in human milk

A

Oleic
Palmitic

77
Q

of carbons in ___ chain amino acids
- short
- med
- long
- very long

A

short: < 6
med: >6-12
long: >12-20
very long: 22 or more

78
Q

measurement for essential FA deficiency

A

triene : tetraene ratio (Holman index)

> 0.2 diagnostic of EFAD

triene = mead acid 20:3 n-9 (from oleic acid)
tetraene = arachidonic acid 20:4 n-6 (from linoleic acid)

79
Q

Role of ____ in PN cholestasis
- high dextrose
- high protein
- IL

A

high dextrose - hepatic steatosis

high protein - canalicular dysfunction

Intra lipid - toxic effects on hepatic cells

80
Q

Target for milk pumping by end of 2nd week

A

350 ml/day

81
Q

90% of Ig in human milk are ____

A

IgA

82
Q

mortality rate for ARPKD

A

30% do not survive beyond neonatal period

83
Q

How quickly can EFAD develop

A

3-7 days w/o LA and ALA

*less than 0.5 mg/kg/d of EFA intake

84
Q

scaly dermatitis
alopecia
thrombocytopenia
increased susceptibility to infection

A

EFAD

85
Q

____g/kg/day lipids (PN)
____g/kg/day lipids (enteral)

fats should provide _____% of total calories

A

3 g/kg/d - PN
4.8-6.6 g/kg/d - enteral

30-50% total calories

86
Q

FeNA equation

A

(Urine Na x Plasma Cr) / (Urine Cr x Plasma Na) x100

Neonates:
< 1% normal
1% - 2.5% pre-renal
>3% intrinsic renal failure

87
Q

Plasma osmolality equation

A

2(Na+) + glucose/18 + BUN/2.8

88
Q

maternal hormone that inhibits milk production when breast is full

A

FIL - feedback inhibitor of lactation

89
Q

Water changes during 1st two weeks for preterm infant a/w weight loss

A

decreased TBW, ECW (esp interstitial)

(increased ICW despite overall decrease in TBW)

90
Q

LBW
VLBW
ELBW

A

LBW <2500 g
VLBW < 1500g
ELBW < 1000g

91
Q

caloric requirements to maintain growth in preterm infant (formula and estimate)

A

(REE x 2) + energy losses

enteral: 110- 120 kcal/day
parenteral: 80-100 kcal/day

92
Q

main component of intralipid

A

soy-based oil

higher concentration of omega 6 than 3

93
Q

More pro-inflammatory FA (omega 3 or 6)

A

omega 6

94
Q

for each gram of protein (enterally) increase of:
____ g/d in weight
_____ cm/wk in HC

A

6.5 g/d
0.4 cm/week

95
Q

Fetal protein/day
_____ from placenta
_____ accretion
______ loss

A

3.5 g/day from placenta
2.5 g/d of accretion
1 g/d loss

96
Q

without protein following delivery, infant will lose ____ g/kg/day of protein stores

A

0.6- 1 g/kg/d

97
Q

Term infant’s glomerular filtration rate ____of adult
GFR reaches adult level by _______

A

50%
2 years of age (longer in preterm)

98
Q

recommended Ca for healthy infants for first 6 mo

A

200mg/day

99
Q

Each gram of weight gain requires _____kcal
(on top of other needs)

A

3.5-4

100
Q

Main AA that are NOT glycogenic (just ketogenic)

A

Leucine
Lycine

101
Q

Which can be seen on 20 week US:
ARPKD or Multicysticdysplastic kidney

A

multi cystic dysplastic kidney disease
–> large echogenic kidneys with thin-walled cysts visible by 20 weeks

ARPKD
–> large echogenic kidneys w/ numerous cysts not seen until later (but can be seen prenatally)
–> a/w hepatic fibrosis and some degree of biliary dysgenesis

102
Q

MC sequelae of ARPKD

A

hypertension (65%)

103
Q

MCC of abdominal mass in the newborn

A

multicystic dysplastic kidney
(though many involute)

104
Q

Calorie % from CHO, Fat, Protein

A

~50% carb
~40% fat
~10% protein

Total calories per day parenteral 70-100kcal/kg/d

105
Q

colostrum has more ____ than mature milk

A

protein

106
Q

Na+ deficit equation

A

0.6 x weight x (Na desired - Na current)

My Neo Board Quickfacts (11 decks)

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