final exam

Question 1

main gluconeogenic substrates

Answer 1

glycerol and alanine

Question 2

thiamine

Answer 2

its deficiency cause wernike korsakoff encephalopathy

Question 3

riboflavin

Answer 3

works as a hydrogen career in krebbs cycle as FAD

Question 4

niacin

Answer 4

works as a hydrogen career in krebbs cycle as NAD

Question 5

panthotenic acid

Answer 5

its a component of CoA as a acil defects

Question 6

piridoxin

Answer 6

it deficiency cause sideroblastic anemia

Question 7

biotin

Answer 7

its a cofactor of carboxylase enzymes in the mitochondria

Question 8

folic acid

Answer 8

it has an important role before and during pregnancy to prevent neutral tube defects

Question 9

cobalamin

Answer 9

its absorbed in the ileum with intrinsic factor produced in the stomach

Question 10

if you have and elderly male px with a Hb of 11.3 mg/dL and VCM of 114; what deficiency do you suspect?

Answer 10

folic acid

Question 11

this mineral has an important role in insuline resistence

Answer 11

chromium

Question 12

this vitamin has been used in neurologic px for its antioxidant properties

Answer 12

vitamin E

Question 13

this vitamin has a crucial role in carboxylation and activation of coagulation factors:

Answer 13

vitamin K

Question 14

if you have a ox with anorexia nervosa, who has been restricting her energy consumption for 2 months; her labs show glucose in upper limit, hypertrigliceridemia and normal albumin; which is the main substrate that she is using?

Answer 14

lipids from adipose tissue

Question 15

regarding proteolysis during metabolic adaptation to simple starvation and stress starvation

Answer 15

lower in starvation that in stress

Question 16

regarding gluconeogenesis during metabolic adaptation to simple starvation and stress starvation

Answer 16

lower starvation and high in stress

Question 17

regarding ketogenesis during metabolic adaptation to simple starvation and stress starvation

Answer 17

higher in starvation than in stress

Question 18

nutritional screening tool recommended by ASPEN for hospitalized px

Answer 18

SGA

Question 19

nutritional screening tool recommended by ESPEN for hospitalized px

Answer 19

NRS

Question 20

absolute gastrointestinal contraindications for enteral nutrition

Answer 20

intestinal obstruction and ileus

Question 21

you have a female px with advance dementia, who suffered a stroke and consequent dysphagia; the neurology doesnt expect a full recovery in the next 3 months; which would be the best option?

Answer 21

EN with gastrostomy

Question 22

you have an obese px who suffered a car accident and is in the ICU, he is tolerating the EN; he is sedated and with hig values of PEEP in the mechanical ventilation; which would be the best option?

Answer 22

nasoyeyunal tube with continuous infusion

Question 23

mention the parameters with which we calculate gastric capacity for the bolus:

Answer 23

5-7 ml/kg per bolus

Question 24

according to ASPEN and ESPEN, how do we advance the infusion rate for continuous EN

Answer 24

start with 20 ml/hr increase 20 every 6-8 hr according to tolerance until you achieve the infusion rate goal

Question 25

according to ESPEN, which is the max osmolarity we can use with a peripheral catheter

Answer 25

850 mosm/L

Question 26

orden according to the best option for a central access, being 1 the first choice and 5 the last one

Answer 26

1. subclavian catheter 2. jugular catheter 3. brachial catheter 4. axillar catheter 5. femoral catheter

Question 27

true

Answer 27

- trilumen catheter have a higher risk of infection - hickmann catheter is an example of a tunneled central catheter

Question 28

false

Answer 28

- portacat catheter shoeld be used for PN for a long period of time - PICCS are collocated for peripherical access - PVI solutions are prederred to chlorhexidine for skin preparation for a CVC

Question 29

its a way to control hypercatabolism other that nutrition:

Answer 29

all of the above: analgesia; pain control/temperature/prevention of infections

Question 30

energy recommendation that you would ose for a undernourished px with a BMI 15.5 to prevent refeeding syndrome

Answer 30

10 kcal/kg

Question 31

in reffeding syndrome ist very important to supplement the following:

Answer 31

thiamine

Question 32

in the prevention of refeeding syndrome, thiamine supplement should be given:

Answer 32

intravenously

Question 33

in the prevention of refeeding syndrome, thiamine should be administered

Answer 33

30 min before nutrition administration starts

Question 34

main electrolyte we need to monitor in a px with refeeding risk

Answer 34

P

Question 35

in the management of anemia in a px with refeeding syndrome, in which way iron supplementation should be administered

Answer 35

after 7 days we started nutritional therapy

Question 36

dose in which we supplement omega 3 in critically ill px as immunotherapy

Answer 36

2000 mg per day

Question 37

dose in which most investigations report toxicity with omega 3 supplementation

Answer 37

over 6 g a day

Question 38

px at risk in which omega 3 supplementation should be carefully assessed and probably should not be used:

Answer 38

thombocytopenia

Question 39

you are using glutamine supplementation to modulate inflammation in critically ill px which via is preferred?

Answer 39

PN

Question 40

dose in which we supplement glutamine in a critically ill px

Answer 40

0.5 g/kg

Question 41

main consideration to supplement a px with glutamine

Answer 41

px live function test must be normal

Question 42

due to the fact that arginine is precursor of nitric oxide, its supplementation is not recommended and/or should be carefully assessed in this type of pathologies

Answer 42

sepsis

Question 43

predominant features of liver disease in px with HPN are:

Answer 43

cholestasis in children and steatosis in adults

Question 44

mention the safest limit for CHO infusion in PN when treating liver disease associate to PN

Answer 44

maximum 5 mg/kg/min

Question 45

main consideration in lipids emulsions for PN in relation with cholestatic syndrome:

Answer 45

combinations of long chain/medium chain fatty acids with polyunsaturated fatty acid seem to reduce the risk

Question 46

when treating cholestatic syndrome as a complication of PN, what should we do in terms of infusion rate?

Answer 46

cycle PN until the liver has recovered

Question 47

when se treat cholestatic syndrome as a complication of long term PN we should consider the following

Answer 47

remove oligoelements from the PN

Question 48

its an important risk factor for metabolic osteopathy as a complication of PN

Answer 48

to much phosphorus in the PN

Question 49

in px with HPN, bone mineral density assessment by DEXA scanning is recommended at the following interval?

Answer 49

yearly

Question 50

accoding to ESPEN guidelines, which is the limit of life expectancy we consider for using PN in a terminally ill px?

Answer 50

3 months

Question 51

under which karnofsky score in a cancer px, HPN is recommended?

Answer 51

50

Question 52

in acute pancreatitis, which should be the preferred via of administration for the nutrition

Answer 52

nasojejunal tube

Question 53

consequence of overfeeding an ICU px

Answer 53

all of the answer are correct: difficulty to wean from ventilator, increased cardiac output, hyperglycemia

Question 54

euglycemic concept in ICU px

Answer 54

140-480 mg/dL