Nutrition

Question 1

What is the most sensitive test for malnutrition?

Answer 1

Albumin

Question 2

Anergy secondary to malnutrition is mediated through what cells?

Answer 2

T-cells

Question 3

What elements are increased in tumor lysis syndrome?

Answer 3

Potassium
Phosphorus
Uric acid

Question 4

Which element is DECREASED in tumor lysis syndrome?

Answer 4

Calcium

Question 5

Which electrolyte abnormality is LEAST consistent with tumor lysis syndrome?

Answer 5

Hypercalcemia, calcium is DECREASED with tumor lysis

Question 6

Which element is most INCREASED with massive transfusion?

Answer 6

Potassium

Question 7

Which element is most DECREASED with massive transfusion?

Answer 7

Calcium

Question 8

What are the benefits of enteral feeds compared to TPN?

Answer 8

Trophic to small gut, decreased risk of infection compared to TPN

Question 9

What non-essential amino acid is essential in patients with critical illness?

Answer 9

Glutamine

Question 10

What is an essential fatty acid in critical illness?

Answer 10

Linolenic acid

Question 11

What causes cholestasis associated with TPN?

Answer 11

Excessive carbohydrate calories

Question 12

What is the most common METABOLIC abnormality with TPN?

Answer 12

Hyperglycemia

Question 13

What is the equation used to calculate basal energy expenditure?

Answer 13

Harris-Benedict
666+(9.6kg)+(1.7cm)-(4.7*yrs)

Question 14

Which factor is Basal energy expenditure most dependent on?

Answer 14

Weight

Question 15

What is the most common ELECTROLYTE abnormality with TPN?

Answer 15

HYPOphosphatemia

Question 16

Where is iron absorbed?

Answer 16

Duodenum

Question 17

What cofactor is required for iron absorption?

Answer 17

Vitamin C

Question 18

Night blindness, weakened immunity, diarrhea, and alopecia are common when deficient in what nutrient?

Answer 18

Zinc

Question 19

Where is folate absorbed?

Answer 19

Duodenum

Question 20

What trace element is needed for the creation of red blood cells?

Answer 20

Copper

Question 21

Postoperative hyponatremia is secondary to what physiologic changes?

Answer 21

Increased ADH and free water retention

Question 22

What is the most common cause of HYPERkalemia?

Answer 22

Renal failure, lab error

Question 23

What are EKG manifestations of HYPERkalemia?

Answer 23

Peaked T-waves, flat p waves, prolonged QRS

Question 24

What is the best ACUTE treatment for HYPERkalemia with EKG changes?

Answer 24

Glucose, insulin, calcium (stabilize cardiac myocytes)

Question 25

What is the best continued treatment for hyperkalemia to deplete stores?

Answer 25

Kayexalate, saline diuresis, dialysis

Question 26

How do you calculate FeNa?

Answer 26

[(urine Na x Plasma Cr)/(Plasma Na x Urine Cr)] x 100

Question 27

What electrolyte abnormality is common with malignant hyperthermia?

Answer 27

HYPERkalemia

Question 28

A patient with stage IIIB SCCC presents with ureteral obstruction, K>7, cr: 9.0, and peaked t-waves. What is the best INITIAL step?

Answer 28

Glucose/insulin (calcium gluconate if an answer choice is more appropriate to stabilize cardiac myocytes

Question 29

What is the most common cause of HYPOkalemia?

Answer 29

Vomiting, diarrhea, malnutrition, alkalosis

Question 30

Which vitamin is required for magnesium absorption?

Answer 30

Vitamin D

Question 31

Which patients are prone to become hypermagnesemic?

Answer 31

Patients with renal failure or acidosis

Question 32

What EKG changes are present in patients who are hypermagnesemic?

Answer 32

Widened PR and QRS

Question 33

What is the treatment for hypermagnesemia?

Answer 33

IV calcium

Question 34

Which patients are prone to become hypomagnesemic?

Answer 34

Patients who have received cisplatin, on diuretics, or radiation enteritis

Question 35

Radiation enteritis can result in bradycardia secondary to loss of what electrolyte?

Answer 35

Magnesium

Question 36

What are some symptoms of low magnesium?

Answer 36

Similar to hypocalcemia: weakness, tetany, QT prolongation

Question 37

What is the most reversible cisplatin toxicity?

Answer 37

Hypomagnesemia

Question 38

Where is calcium absorbed?

Answer 38

Duodenum

Question 39

What forms does calcium circulate in?

Answer 39

45% ionized, 40% protein bound, 15% bound tightly to other ions

Question 40

What are common causes of hypercalcemia in cancer patients?

Answer 40

Lytic bone lesions, secretion of PTH-like peptides, thiazide diuretics

Question 41

What are symptoms of hypercalcemia?

Answer 41

Short QT, weakness, confusion, nausea/vomiting

Question 42

What are options for treatment of hypercalcemia?

Answer 42

Hydration, lasix, calcitonin (rapid onset 48 hrs duration of action), zolendronic acid

Question 43

What is the most common EKG finding of hypercalcemia?

Answer 43

Shortened QT internal

Question 44

What are causes of hypocalcemia in cancer patients?

Answer 44

Malnutrition, hypomagenesemia, tumor lysis syndrome

Question 45

What are clinical signs of hypocalcemia?

Answer 45

Chvosteks sign, prolonged QT and ST

Question 46

What is the most common electrolyte abnormality with TPN?

Answer 46

Hypophosphatemia

Question 47

What are the symptoms of hypophosphatemia?

Answer 47

Weakness, mental status changes

Question 48

What hormone mediates the release of phosphate?

Answer 48

PTH

Question 49

Where is phosphorous stored?

Answer 49

Bone

Question 50

What are common causes of metabolic acidosis?

Answer 50

GI loss, ketoacidosis, lactic acidosis, ASA, Tylenol or methanol ingestion, renal tubular acidosis

Question 51

Which causes of metabolic acidosis cause an anion gap?

Answer 51

Lactic, ASA, Tylenol, DKA

Question 52

What is the expected change in PH associated with a change of 10 pCO2?

Answer 52

0.08

Question 53

What are causes of high anion gap?

Answer 53

Lactic acidosis (sepsis), DKA, ASA, ESRD

Question 54

Which patient will likely have a non-gap acidosis?

Answer 54

Renal tubular acidosis and a patient with a transverse colon conduit

Question 55

What is the LEAST likely to produce acidosis?

Answer 55

Vomiting