Nutrition

Question 1

Yellowish tinge to the skin without scleral icterus. What do you suspect?

Answer 1

Hypercarotenemia (eating a lot of yellow-orange vegetables including squash, carrots, etc).

Question 2

True or false. Zinc deficiency can be associated with cystic fibrosis

Answer 2

True. Zinc-binding ligands may be missing from the intestinal tract.

In the setting of otherwise healthy children, usually occurs when you stop breastfeeding (breast milk contains zinc-binding ligands).

Question 3

What are signs of a Vitamin E deficiency?

Answer 3

Neurological defects and hemolytic anemia.

Question 4

Kwashiorkor vs Marasmus differences?

Answer 4

Kwashiorkor- protein malnutrition with otherwise close to normal daily nutritional intake

Marasmus- general total caloric deficiency

Question 5

Moon face, protuberant belly, lower extremity pitting edema– name the nutritional disorder; otherwise fairly normal height, weight for age.

Answer 5

Kwashiorkor

Question 6

Generalized FTT with poor weight gain and height gain. Fine hair, brittle nails/teeth. Once fed, remains vigorously hungry.

Answer 6

Marasmus.

Question 7

Niacin deficiency symptoms?

Answer 7

Vitamin B3 deficiency; triad of 3D’s– diarrhea, dermatitis, dementia

Question 8

Canal necklace, angular chelitis and mucositis, glove and stocking distribution of dermatitis, dementia–name the vitamin deficiency?

Answer 8

Pellagra 2/2 niacin deficiency (Vit B3)

Question 9

Name the vitamin deficiency: generalized myalgias, gingivitis and bleeding of gums, loss of teeth, irritability, X-ray of long bones shows ground glass appearance of bones and cortical thinning, petechia and hyperkeratosis of hair follicles?

Answer 9

Scurvy or Vitamin C deficiency.

Question 10

Crohn’s disease has an increased risk of deficiency of which vitamins?

Answer 10

Vitamin A/D/E/K and vitamin B12 deficiency (terminal ileum is affected, leading to issues with Vit B12 absorption–pernicious anemia)

Question 11

Does fluoride pass through breast milk?

Answer 11

No, not even if MOP drinks fluorodinated water

Question 12

When do you worry about supplying fluoridinated water?

Answer 12

Starting at 6 months old.

Question 13

Calculate the fluid reqs for a 25kg child who also has a 5% fluid deficit.

Answer 13

100/50/20 rule 
First 10kg, 100ml/kg= 1000mL
Second 10kg, 50ml/kg= 500mL
Last 5kg, 20ml/kg= 100mL
Total maintenance= 1600mL

25kg x 0.05 deficit= 1.25L or 1250mL
1600mL + 1250mL = 2850mL over 24 hours

Question 14

Kwashiorkor rash?

Answer 14

Generalized rash with “flaky paint dermatitis”; red-brown raised scales that easily peels off with underlying layer of blanching erythema due to severe protein malnutrition

Question 15

Why are premature infants more susceptible to Vit E deficiency?

Answer 15

Transfer of Vit E through the placenta occurs during the third trimester; premature infants are therefore susceptible to hemolytic anemia 2/2 Vit E deficiency, especially in the 2nd month of life.

Question 16

What vitamin should be supplemented in strict vegans?

Answer 16

Vitamin B12

Question 17

True or False. Women with breast implants are unable to breast-feed their children.

Answer 17

FALSE. Breast implantation does not destroy alveolar tissue that produces the milk.

Question 18

True or False. A contraindication to breast-feeding is moms with breast implants.

Answer 18

FALSE. No studies to show leaching of silicone into milk to support negative effects of breast feeding while having implants.

Question 19

True or False. You can start a soy formula in a preterm infant.

Answer 19

FALSE. Soy formulas can only be used in term infants.

Question 20

In which infants can you recommend soy formulas?

Answer 20

Term infants, infants of vegan families (no animal products–therefore no cow’s milk), and infants with galactosemia

Question 21

Vitamin A deficiency symptoms?

Answer 21

Eye-issues; concerns about impending blindness

Question 22

Vitamin A excess symptoms

Answer 22

Neurological symptoms due to increased ICP; pseudotumor cerebri, papilledema, headaches, vomiting, dry mucous membranes (eyes/mouth), hyperostosis of bones (thin, wavy thickening of bones)

Question 23

Vitamin K deficiency issues?

Answer 23

Hemorrhagic disease of the newborn– newborns lack gut enzymes to make Vitamin K

Question 24

What should you give to a newborn with hemorrhagic disease?

Answer 24

Vitamin K AND FFP (contains Vitamin K dependent factors that can act to stop bleeding)

Question 25

Vitamin E deficiency?

Answer 25

Hemolytic anemia Decreased reflexes Associated with receiving TPN

Question 26

Vitamin D excess?

Answer 26

Hypercalcemia with Ca2+ induced diuresis, hyperphosphatemia, increased kidney stones

Question 27

Widening of physis (growth plates-- wrists and ankles), frontal bossing, pigeon chest, ricketic rosary, pigeon chest-- what vitamin deficiency?

Answer 27

Vit D-- rickets

Question 28

Which vitamin deficiency can be associated with cardiomegaly?

Answer 28

Thiamine (Vitamin B1 deficiency-- Beriberi)

Question 29

Pellagra is commonly seen in children who each a diet rich in what type of food?

Answer 29

Corn

Question 30

Vitamin B1 (Thiamine) deficiency?

Answer 30

Peripheral vasodilation related to B1 deficiency--high output cardiac failure. Ataxia, neuropathy/encephalopathy/delirium (Wernicke's) Korsakoff syndrome- retrograde and anterograde amnesia

Question 31

Riboflavin (B2) deficiency?

Answer 31

Angular chelitis, glossitis

Question 32

Pyridoxine deficiency is associated with which drug regimen?

Answer 32

B6 deficiency, associated with isoniazid therapy for TB; look for neuro symptoms

Question 33

Biotin deficiency?

Answer 33

B7 deficiency-- associated with alopecia, rash and neuro-findings (ataxia)

Question 34

Folate deficiency?

Answer 34

``` Vitamin B9 (macrocytic anemia, swollen red tongue), NTD defects in newborns of mothers deficient in folate Associated with a history of goat milk ingestion (poor in folic acid) ```

Question 35

Zinc deficiency?

Answer 35

Associated with weaning off of breast milk (MBM has zinc-binding ligand); severe scaly and erythematous dermatitis around natural orifices

Question 36

True or False. Acrodermatitis enteropathica is a disorder that just describes overall Zinc deficiency.

Answer 36

FALSE. It describes an inherited (AR) form of Zinc deficiency due to Zinc transporter defect. Results in diarrhea, FTT, alopecia AND rash of zinc deficiency.

Question 37

Energy requirement calculation formula

Answer 37

Same as fluid calculations, except use kcal for mL: | 100kcal/kg for first 10kg, then 50kcal/kg for next 10kg, then 25 kcal/kg beyond that

Question 38

Essential fatty acid deficiencies findings

Answer 38

Linoleic and alpha-linolenic acid deficiencies | Alopecia, scaly dermatitis, and thrombocytopenia

Question 39

Tocopherol is another name for which Vitamin? Deficiency? Toxicity?

Answer 39

Vitamin E Deficiency: Hemolytic anemia Toxicity: Hepatotoxicity

Question 40

Infant fed a solely evaporated milk diet; what deficiency and disorder would you expect to see?

Answer 40

Lacking in Vitamin C (scurvy); | irritability, gum swelling, petechiae, ground glass appearance of cortical bone

Question 41

Laboratory signs of chronic alcohol abuse?

Answer 41

Elevated GGT and increased MCV