HARK CASE STUDY Q's - MASTER Flashcards
(37 cards)
The CDC states that lead poisoning, which causes learning and behavioral problems and organ damage affects______ young children.
a. 1:10
b. 1:38
c. 1:76
b. 1:38
* While there is NO SAFE or acceptable blood level of lead, more than half a million American children between 1-5 yo have BLLs more than 5 micrograms/dL.
True or false? The largest contributor of lead contamination in the environment is from leaded fuel.
True.
- Current major sources of lead emissions are ore and metal processing and aircraft engines operating on leaded aviation fuel.
https: //www.scientificamerican.com/article/lead-in-aviation-fuel/#:~:text=While%20jets%2C%20which%20comprise%20the,a%20real%20air%20quality%20issue.
The primary sources of pediatric lead poisoning in the U.S are (select all that apply):
a. chipped paint
b. leaded fuel
c. contaminated soil and dust from chipped paint
d. pencils
a and c
*1972 - lead in house paint was banned (1% lead content or higher). 1997 that threshold was changed to 0.06%. It is estimated that about 2/3 of homes built in the 1960’s and 1970’s used lead containing paint.
Other sources of lead include (select all that apply):
a. well water
b. occupational
c. artist paint
d. ammunition
e. food
f. toys
all (a-f).
- In the past lead was used for plumbing so could come into contact if older plumbing systems erode. 1991 EPA regulated lead (and copper) in public sector, however private wells that serve less than 25 people are not regulated thus still at risk.
- Occupational - lead miners, refiners, smelters, construction workers
- Shooting range, gunsmiths, police officers at risk - can come home on police officers clothes, putting family at risk.
- Lead in soil, air, and water can contaminate food. Moonshine really high in lead due to using automobile radiators for the distillation process. Dinnerware, lead from glaze and paints on servingware. Lead from imported medications, herbs, cosmetics, ayurvedic remedies.
- 1978 lead paint on childrens toys banned in U.S, however not banned for toys imported from other countries.
For children, a blood lead level over ____micrograms/dL is considered an “area of concern”
a. 3
b. 5
c. 10
d. 1
b. 5 (though it should be anything)
Lead is absorbed primarily through the _____ and the _____.
a. Skin, GI tract
b. GI tract, lungs
c. lungs, mucous membranes
d. skin, lungs
b. GI tract (40-45%) - ingested particles, and lungs (30-40% inhaled particles.
* iron, calcium, and zinc deficiencies can exacerbate lead absorption in the GI tract
Children store _____% of lead burden in their bone.
a. 30
b. 50
c. 70
d. 100
c. 70, while adults store 90% of lead burden in their bone.
* this is why new bone formation is impaired in lead toxicity, also “lead lines” -https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)13946-3/fulltext
Lead depletes _____ due to its affects on renal biogenesis of the vitamin.
a. vitamin C
b. vitamin B6
c. vitamin D
d. vitamin E
c. vitamin D
* Lead inhibits the mitochondrial P450 1-hydroxylase enzyme needed to synthesize vitamin D. This leads to lack of D for adequate calcium homeostasis, thus bone formation negative impacts.
The biologically active form of vitamin D is:
a. calcitriol
b. ergocalciferol (D2)
c. cholecalciferol (D3)
a. calcitriol - 1,25{OH}2D3
* Calcitriol: 1. promotes cell differentiation. 2. Intestinal absorption of calcium and phosphorous. 3. stimulates osteoclast - mediated bone resorption.
Vitamin D deficiency in kids can cause _________ (condition that begins with R), and in adults can cause ____________- (condition that begins with O).
Rickets, osteomalacia.
*Most common signs of osteomalacia - bone and muscle weakness, tingling in extremities (calcium deficiency), bone fractures.
Burning chest pain and stomach pain relived by antacids are symptoms in a young female athlete that may trigger a clinician to consider:
a. Riboflavin deficiency
b. an eating disorder
c. heartburn
d. overexercise
b. an eating disorder - c/b purging type.
* Laboratory hypokalemia and alkalosis can also suggest vomiting.
A young adult with an eating disorder is at risk for ______ deficiency:
a. calcium
b. biotin
c. vitamin C
d. niacin
a. calcium
* Infants and adolescents have higher calcium requirements. Hormonal changes in puberty and growth increase the need (1,300mg/day), however only 20% (of non-vomiting) girls meet the RDA for calcium.
Obstructive sleep apnea (OSA) is a medical condition characterized by intermittent airway closure during sleep. These airway closures lead to intermittent drops in oxyhemoglobin saturation, which triggers a surge in sympathetic activity and an arousal from sleep.
The three largest risk factors for sleep apnea include obesity, male gender, and middle-age.
True/False: The diagnostic gold standard for sleep apnea is an in-laboratory polysomnography (PSG)
aka - or an overnight “sleep study”
A large prospective study found that persons with apnea experience increased risk of future development of hypertension.
The solution for OSA is A. B12 injections B. Vitamin D 10,000 IU C. CPAP D. All of the above
C. CPAP
Randomized, controlled trials show that CPAP therapy reduces blood pressure and insulin resist- ance and improves neuro-cognitive function
According to the NCEP ATP III definition, metabolic syndrome is present if three or more of the following five criteria are met:
- waist circumference over 40 inches (men) or 35 inches (women)
- blood pressure over 130/85 mmHg
- fasting triglyceride (TG) level over 150 mg/dl
- fasting high-density lipoprotein (HDL) cholesterol level less than 40 mg/dl (men) or 50 mg/dl (women)
- fasting blood sugar over 100 mg/dl.
:(
Those with CF are at risk of developing (most commonly) deficiencies of: A. The B vitamins B. Fat soluble vitamins C. amino acids D. all of the above
Patients with CF are at risk for developing multiple fat-soluble vitamin deficiencies with their associated clinical manifestations.
Deficiencies of water-soluble vitamins are less common; however, vitamin B12 deficiency pro- duces macrocytic anemia and neuropathy.
Fat malabsorption, which occurs when CF patients are not receiving (or are not complying with) pancreatic enzyme replacement therapy, impairs the digestion of the glycoproteins known as R binders, which are necessary for the transfer of vitamin B12 to intrinsic factor (IF).
Osteopenia is also commonly seen in CF patients, which may be due to malabsorption, decreased calcium intake, vitamin D deficiency, delayed puberty, reduced physical activity, medications (e.g., corticosteroids), and high circulating levels of inflammatory cytokins related to lung infections.
MNT for CF:
Even with appropriate pancreatic enzyme therapy, fat malabsorption and associated fat-soluble vitamin deficiencies may still persist in patients with CF. A daily multivitamin supplement, enriched in fat-soluble vitamins A, D, E, and K that are in a water-miscible form to improve absorption, is indicated. Since vitamin K is produced by gut micro-organisms, antibiotic therapy significantly decreases gut bacteria and, as a result, diminishes vitamin K production. Therefore, vitamin K supplements are often given to patients with CF, especially those receiving chronic antibiotic therapy (at least 2.5 to 5 mg per week).
Vitamin D deficiency is also common in patients with CF. Based on updated guidelines, vitamin D deficiency should be treated by doubling the amount of vitamin D3 (cholecalciferol) in their current supplements and re-checking the 25-hydroxy vitamin D level 3 months after supplementation is increased. Serum vitamin A, E, 25-hydroxy vitamin D, and PIVKA-II levels should be checked annually in all patients with CF and deficiencies should subsequently be treated.
There is a significant association between _______ and nutritional deficit in the elderly even after adjusting for variables such as low educational and socioeconomic level, and smoking.
a. lower lifespan
b. depression
c. heart attack
b. depression
* A study by Cabrera et al. found depression in 24.3% of elderly subjects (Hark, pg. 217).
Elderly are at risk for _______ deficiency, especially if they are homebound.
a. vitamin C
b. zinc
c. vitamin D
d. copper
c. vitamin D
* Depression can increase the likelihood of an elderly individual being homebound, thus less sun exposure and increase risk of vitamin D deficiency.
The following would be prudent to implement with an elderly individual:
a. multimineral supplement with 100% RDA for calcium for older adults (600mg).
b. multivitamin supplement with at least 1000 IU vitamin D3 daily.
c. both a and b
c. a multivitamin/multimineral supplement with 600mg calcium and at least 1000 IU vitamin D3.
Focus for constipation in older adults should be on:
a. fiber
b. hydration
c. exercise
d. all of the above
d. all of the above
The number one cause of blindness in developing countries and the third leading cause of blindness internationally is ________.
a. cataracts
b. glaucoma
c. macular degeneration
c. age related macular degeneration
* the macula contains the most densely packed area of photoreceptors, which allows from the majority of functional vision.
The two major forms of AMD are non-neovascular (“dry/atrophic”) and neovascular (“wet”). Non-neovascular AMD accounts for _____% of cases, while neovascular accounts for _____%.
a. 10, 90
b. 90, 10
c. 20, 80
d. 80, 20
b.
Non-neovascular (dry) AMD accounts for 90% of AMD cases, and is characterized by yellowish deposits of extracellular material called drusen in the retina and degeneration of the photoreceptors. This version progresses slowly over many years and seldom causes severe vision loss. (less severe, more common).
Neovascular (wet) AMD accounts for 10% of AMD cases, and is characterized by abnormal blood vessels in the retina which leads to leakage of blood, fluid, and lipids, causing fibrous scars to form. More than 80% of severe vision loss is due to this form of the disease (more severe, more rare).
