Nutrition Flashcards
(166 cards)
1
Q
Hi there ๐ซต ุณู ููู ุงููู
A
ุจุณู ุงููู ุงูุฑุญู ู ุงูุฑูุญูู ๐ก
2
Q
What is the daily caloric requirement for full-term and preterm infants โ๏ธ
A
๐ผ 100โ140 kcal/kg/day
##Footnote
๐ง Required to support normal infant growth
3
Q
How much extra energy is needed for catch-up growth in malnourished childrenโ๏ธ
A
๐ 20โ30% more than baseline requirements
4
Q
What is the daily protein requirement in preterm vs full-term infants โ๏ธ
A
๐ถ Preterm: 3.5 g/kg/day
๐ถ Full-term: 2โ2.5 g/kg/day
5
Q
How many calories are provided per gram of macronutrients โ๏ธ
A
๐ฅ Carbohydrates = 4 kcal/g
๐ฅฉ Protein = 4 kcal/g
๐ฅ Fat = 9 kcal/g
6
Q
What is the caloric content of standard infant formula โ๏ธ
A
๐ผ 20 kcal/oz = 20 kcal/30 mL
7
Q
A full-term infant requires 2.5g/kg of protein and 100โ140 kcal/kg/day. How many kcal does 30 mL of formula typically provide โ๏ธ
A. 10 kcal
B. 20 kcal
C. 30 kcal
D. 40 kcal
A
๐
B. 20 kcal
## footnote
๐ง Standard formula is 20 kcal per 30 mL (1 oz)
8
Q
What is the primary carbohydrate in breast milk โ๏ธ
A
๐ฌ Lactose
9
Q
What is the main protein in breast milk โ๏ธ
A
๐ฅ Alpha-lactalbumin (ฮฑ-lactalbumin)
10
Q
What are the key fatty acids present in breast milk โ๏ธ
A
๐ง Arachidonic acid (ARA)
๐ง Docosahexaenoic acid (DHA)
## footnote
โ
Important for brain and visual development
11
Q
What are absolute contraindications to breastfeeding (mnemonic: HIM) โ๏ธ
A
๐ซ Human T-lymphotropic virus (HTLV)
๐ซ Infant with galactosemia
๐ซ Mother with active TB (until 2 weeks of effective therapy)
โ โ ๏ธ Phenylketonuria : Breastfeeding may be allowed with restricted dietary phenylalanine
12
Q
Which of the following is an absolute contraindication to breastfeeding โ๏ธ
A. Maternal diabetes
B. Infant with galactosemia
C. Cesarean delivery
D. Jaundiced newborn
A
๐
B. Infant with galactosemia
## footnote
๐ง Inability to metabolize galactose โ life-threatening complications
13
Q
What are the features of standard humanized formulas and when are they used โ๏ธ
A
๐น Modified to mimic breast milk
๐น Lipids = vegetable oils; fortified with iron, vitamins, and minerals
โ
First-line for healthy infants <6 months
14
Q
How do follow-on milk formulas differ from standard humanized formulas โ๏ธ
A
๐ Higher protein content (3 g/dL)
โ
Used for healthy infants >6 months of age
15
Q
What is the modification in lactose-free formulas, and when are they indicated โ๏ธ
A
โ Lactose replaced with sucrose
โ
Indications:
โโข Lactose intolerance*
โโข Galactosemia
โโข Post-infectious persistent diarrhea
16
Q
What is the protein source in soya-based formulas, and when are they used โ๏ธ
A
๐ฅ Soy protein replaces cowโs milk protein
โ ๏ธ Contains phytoestrogens and aluminum
โ
Indications:
โโข Cowโs milk allergy
โโข Persistent diarrhea
##Footnote
โ ๏ธ May cause soy allergy
17
Q
What is the role of elemental (hypoallergenic) formulas and what do they contain โ๏ธ
A
๐งช Protein = peptides & amino acids
๐งช Lipids = medium-chain triglycerides (MCT)
โ Poor taste and expensive
โ
Indications:
โโข Allergy to both cowโs milk and soy
โโข Chronic diarrhea, malabsorption (e.g. cystic fibrosis )
18
Q
What are the key features of preterm infant formulas โ๏ธ
A
๐ Higher calories (81 kcal/100 mL)
๐ More protein, MCTs, monosaccharides, added minerals
โ
Used for weight gain in preterm infants before discharge
19
Q
What are proven health benefits of breastfeeding โ๏ธ
A
โ
Reduces risk of:
โโข Obesity
โโข Otitis media (acute & recurrent)
โโข UTI, diarrhea, NEC (necrotizing enterocolitis)
โโข Type 2 diabetes, celiac, Crohnโs disease
โโข Lymphoma, leukemia, and allergies
20
Q
Which infant formula is best for a baby with both cow milk and soy protein allergy and chronic diarrhea โ๏ธ
A. Soya formula
B. Lactose-free formula
C. Humanized formula
D. Elemental formula
A
๐
D. Elemental formula
##Footnote
๐ง Contains peptides/amino acids and MCTs; used in allergy + malabsorption
21
Q
What causes marasmus โ๏ธ
A
๐ Severe caloric deficiency (chronic undernutrition)
๐ง Both protein and energy are deficient
22
Q
What are the clinical features of marasmus โ๏ธ
A
๐ป Severe muscle wasting
๐ป Hypotonia, wrinkled skin, senile facies
๐ป Visible intestinal pattern, shrunken limbs
โ๏ธ Subnormal temperature, slow pulse
23
Q
What is the caloric content of standard infant formula โ๏ธ
A
๐ผ 20 kcal/oz = 20 kcal/30 mL
24
Q
How is marasmus classified by degree of weight loss โ๏ธ
A
๐ธ 1st degree : 15โ25% loss โ abdomen
๐ธ 2nd degree : 25โ35% loss โ buttocks/thighs
๐ธ 3rd degree : >35% loss โ face (senile facies)
25
**What causes kwashiorkor** โ๏ธ
๐ **Severe protein deficiency** with **adequate caloric intake** , mainly **carbohydrates**
26
**What are the clinical features of kwashiorkor** โ๏ธ
๐ **Edema**
๐ **Fatty liver / hepatomegaly**
๐ **Muscle wasting** , but **subcutaneous fat may be preserved**
๐ง **Anorexia, lethargy, irritability**
๐งฌ **Increased infection susceptibility**
27
**What are the dermatologic and hair changes seen in kwashiorkor** โ๏ธ
๐ค **Patchy skin with hyper/hypopigmentation**
๐ง๐ฟ **Hair** : sparse, thin, streaky red or gray (especially in dark-skinned children)
28
**A child presents with edema, irritability, fatty liver, and hypopigmented skin. What is the diagnosis** โ๏ธ
A. Marasmus
B. Iron deficiency anemia
C. Kwashiorkor
D. Celiac disease
๐
**C. Kwashiorkor**
##Footnote
๐ง Protein malnutrition with edema and skin/hair changes
29
**What are the main dietary sources of riboflavin (Vitamin B2)** โ๏ธ
๐ฅฉ **Meat** , ๐ **fish** , ๐ฅ **eggs** , ๐ฅ **milk** , ๐ **yeast** , ๐ฅฌ **vegetables**
30
**What are common risk factors for riboflavin deficiency** โ๏ธ
๐ผ **Prolonged phototherapy** in preterm infants
๐ฉโ๐ฆฐ **Adolescent females** (due to dietary restriction)
โ ๏ธ **Low socioeconomic status**
31
**What are the oral and skin symptoms of riboflavin deficiency** โ๏ธ
๐ Cheilosis (cracks/fissures at mouth corners)
๐
Glossitis (smooth, red tongue)
๐งด Seborrheic dermatitis
32
**What are the ocular and hematologic signs of riboflavin deficiency** โ๏ธ
๐๏ธ **Photophobia**
๐๏ธ **Corneal vascularization**
๐ฉธ **Anemia** due to **erythroid hypoplasia**
33
**A child on prolonged phototherapy develops glossitis, cheilosis, and photophobia. What vitamin deficiency is most likely** โ๏ธ
A. Vitamin A
B. Vitamin B1
C. Vitamin B2
D. Vitamin B6
๐
**C. Vitamin B2 (Riboflavin)**
## footnote
๐ง Classic signs: **cheilosis + glossitis + photophobia**
34
**What are the main dietary sources of thiamine (Vitamin B1)** โ๏ธ
๐ฅฉ **Meat** , ๐ฅ **milk** , ๐ฅฌ **vegetables** , ๐ฑ **legumes** , ๐ **yeast**
35
**What is the chemical structure of thiamine** โ๏ธ
๐พ **Yeast** , ๐ **rice** , ๐ฅฉ **meat** , ๐ฅ **nuts** , ๐ฝ **cereals**
36
**What is the classic triad of Wernicke encephalopathy (due to thiamine deficiency)** โ๏ธ
๐ง **Altered mental status**
๐ถโโ๏ธ **Ataxic gait**
๐๏ธ **Ophthalmoplegia**
37
**What is Wernicke-Korsakoff syndrome** โ๏ธ
๐ง **Wernicke encephalopathy + Korsakoff psychosis**
โก๏ธ **Confusion** , **nystagmus** , **ophthalmoplegia** , **memory loss** , **psychosis** , and **hemorrhage (ICH)**
38
**What are the features of wet beriberi (infantile and adult)** โ๏ธ
โค๏ธ **Congestive heart failure**
๐ฆป **Hoarseness or aphonia**
๐ง **Neuritis**
โ **Absent deep tendon reflexes**
39
**What are the symptoms of dry beriberi** โ๏ธ
๐ **Peripheral neuritis**
๐ฆต **Severe leg pain**
โ No edema
40
**A malnourished patient presents with confusion, nystagmus, and ataxia. What is the likely diagnosis** โ๏ธ
A. Dry beriberi
B. Wernicke encephalopathy
C. Pellagra
D. Wet beriberi
๐
B. Wernicke encephalopathy
##Footnote
๐ง Classic triad: **confusion + ataxia + ophthalmoplegia**
41
**What are dietary sources of niacin (Vitamin B3)** โ๏ธ
๐ฅ **Milk**
๐ฅ **Eggs**
42
**What are common causes of niacin deficiency** โ๏ธ
๐บ **Alcoholism**
๐ **Prolonged isoniazid (INH) therapy**
โ **Malabsorptive diseases**
๐ **Anorexia nervosa**
43
**What is the classical tetrad of symptoms in niacin deficiency (pellagra)** โ๏ธ
๐ท The 4 **Dโs** of pellagra:
1๏ธโฃ **Diarrhea**
2๏ธโฃ **Dementia**
3๏ธโฃ **Dermatitis**
4๏ธโฃ **Death** (if untreated)
44
**A malnourished patient with chronic diarrhea, confusion, and a photosensitive rash likely has which deficiency** โ๏ธ
A. Riboflavin
B. Vitamin C
C. Niacin
D. Thiamine
๐
**C. Niacin**
## footnote
๐ง Classic pellagra: diarrhea, dementia, dermatitis
45
**What are common dietary sources of pyridoxine (Vitamin B6)** โ๏ธ
๐พ **Yeast** , ๐ **rice** , ๐ฅฉ **meat** , ๐ฅ **nuts, ๐ฝ cereals
46
**What are common causes of B6 deficiency** โ๏ธ
๐ **Isoniazid (INH) therapy**
๐คฑ๐ผ **Exclusive breastfeeding >6 months** if mother is B6 deficient
๐งฌ **Pyridoxine-dependent seizures**
๐งฌ **Inherited syndromes** (e.g. **homocystinuria** )
47
**What hematologic condition is associated with B6 deficiency** โ๏ธ
๐ฉธ **Microcytic anemia**
48
**What is a hallmark neurological presentation of B6 deficiency in infants** โ๏ธ
โก **Refractory seizures** (especially in first 18 months)
๐ง Consider **pyridoxine-dependent seizure**
49
**What other neurologic and dermatologic features may be seen in B6 deficiency** โ๏ธ
๐ **Sensory neuropathy**
๐งด **Dermatitis**
50
**What is the recommended action in unexplained early-onset seizures in infants** โ๏ธ
๐ **Trial of pyridoxine**
๐ง Especially when **etiology is unclear and age <18 months**
51
**A 2-month-old infant has refractory seizures with no known etiology. What should be administered empirically** โ๏ธ
A. Folic acid
B. Thiamine
C. Pyridoxine
D. Diazepam
๐
**C. Pyridoxine**
## footnote
๐ง Consider **B6 deficiency** in all early unexplained seizures
52
**What are the primary dietary sources of Vitamin B12** โ๏ธ
๐ฅฉ **Animal products only**
๐ง Meat, fish, dairy, and eggs
โ **Absent in plant-based foods**
53
**What is the biochemical role of B12 in metabolism** โ๏ธ
๐ **Methylation of homocysteine to methionine**
๐ **Demethylation of methyltetrahydrofolate (MTHF) to tetrahydrofolate (THF)**
โก๏ธ **THF is essential for DNA synthesis**
๐ง Also crucial for **myelin sheath maintenance**
54
**What are common causes of Vitamin B12 deficiency** โ๏ธ
๐ฅ **Strict vegans**
๐ฉบ **Ileal resection**
๐ฆ **Crohnโs disease**
๐ถ **Breastfed infant of a B12-deficient mother**
55
**What is the most common clinical scenario for B12 deficiency in infants** โ๏ธ
๐ถ **Exclusively breastfed infant** whose mother is **B12-deficient**
56
**What adolescent population is at risk of B12 deficiency** โ๏ธ
๐ฅ **Strict vegan adolescents** (no animal product intake)
57
**A vegan mother breastfeeds exclusively. Her infant presents with failure to thrive and developmental delay. What deficiency is likely** โ๏ธ
A. Vitamin D
B. Folic acid
C. Vitamin B12
D. Iron
๐
**C. Vitamin B12**
## footnote
๐ง Vegan diet = B12 deficiency = impaired **DNA synthesis + myelination**
58
**What hematologic abnormality is characteristic of B12 deficiency** โ๏ธ
๐ **Megaloblastic anemia**
๐ฌ **Hypersegmented neutrophils** on peripheral smear
59
**What are the neurologic symptoms of B12 deficiency** โ๏ธ
โก **Paresthesia**
๐ง **Peripheral neuritis**
๐ Risk of irreversible **myelopathy** if untreated
60
**What are other systemic symptoms of B12 deficiency**โ๏ธ
๐ **Failure to thrive (FTT)**
๐ด **Fatigue**
๐จ **Skin hyperpigmentation**
๐คข **Vomiting and diarrhea**
61
**In a toddler with surgical removal of terminal ileum, what deficiency is most likely** โ๏ธ
โ
**Vitamin B12**
## footnote
๐ง Absorbed in the terminal ileum, so its resection leads to deficiency
62
**A toddler had terminal ileum resection and is now on cow milk formula. Which deficiency is most likely** โ๏ธ
A. Phosphorus
B. Amino acids
C. Vitamin B12
D. Triglycerides
๐
**C. Vitamin B12**
## footnote
๐ง Terminal ileum is essential for B12 absorption
63
**What are common causes of folic acid deficiency** โ๏ธ
๐ฅ **Goat milk intake** (lacks folate)
๐ฆ **Crohnโs disease**
๐งฌ **Sickle cell anemia**
๐ **Drugs: Phenytoin, Methotrexate**
64
**What are the key clinical features of folic acid deficiency** โ๏ธ
๐ **Megaloblastic anemia**
๐ฌ **Hypersegmented neutrophils**
๐ **Growth retardation** in children
65
**What lab tests are used to evaluate folic acid deficiency** โ๏ธ
๐งช **Serum folate**
๐งช **Serum cobalamin** (to rule out coexisting B12 deficiency)
66
**What fetal abnormality is associated with maternal folate deficiency** โ๏ธ
๐จ **Neural tube defects**
๐ง Spina bifida, anencephaly
67
**What is the standard folic acid supplementation dose for women of reproductive age** โ๏ธ
๐ **0.4โ0.8 mg/day**
68
**What is the folic acid dose for women with a history of neural tube defect in prior pregnancy** โ๏ธ
๐ **4 mg/day**
## footnote
๐ง Start **before conception**
69
**A 2-year-old on goat milk presents with macrocytic anemia and hypersegmented neutrophils. What is the likely diagnosis**โ๏ธ
A. Iron deficiency
B. Vitamin B12 deficiency
C. Folic acid deficiency
D. Thalassemia
๐
**C. Folic acid deficiency**
## footnote
๐ง Goat milk is folate-deficient, leading to megaloblastic anemia
70
**What are the common dietary sources of Vitamin C** โ๏ธ
๐ **Citrus fruits** , ๐ฅฌ **green leafy vegetables** , ๐ผ **human & cow milk**
71
**What are the classic clinical features of scurvy (Vitamin C deficiency)** โ๏ธ
๐ฆท **Gingivitis, loose teeth, spongy & sore gums**
๐ฉธ **Cutaneous hemorrhage, easy bruising, purpura**
๐ฆต **Leg tenderness, subperiosteal hemorrhage, pseudoparalysis**
โ **Poor wound healing**
72
**What is a hallmark radiologic sign of scurvy in bones** โ๏ธ
๐ธ **โTrรผmmerfeld zoneโ** โ classic radiologic finding
## footnote
๐ง Also seen: cortical thinning and dense metaphyseal lines
73
**What are additional signs seen in children with scurvy** โ๏ธ
๐งถ **Corkscrew hair**
๐ฆต **Woody legs, swollen joints**
๐ง May present as **refusal to walk** or **pseudoparalysis**
74
**What are side effects of excessive Vitamin C intake** โ๏ธ
โ **Renal colic (nephrolithiasis)**
โ **Diarrhea, nausea**
โ **Hemolysis in G6PD deficiency**
โ **Dental decalcification**
75
**A 5-year-old boy with autism eats only schnitzel and water, has gingival bleeding and leg pain, and refuses to walk. What is the most likely cause** โ๏ธ
A. Hypervitaminosis A
B. Vitamin B deficiency
C. Vitamin C deficiency
D. Hypervitaminosis D
E. Vitamin E deficiency
๐
**C. Vitamin C deficiency**
##Footnote
๐ง Poor diet + gingivitis + refusal to walk = classic scurvy
76
**What are the fat-soluble vitamins** โ๏ธ
๐ง **A, D, E, and K**
77
**What factors are essential for the proper absorption of fat-soluble vitamins** โ๏ธ
๐ธ **Surface area** (e.g., small intestine)
โก๏ธ Impaired in **short bowel syndrome**
๐ธ **Pancreatic enzymes**
๐ธ **Bile salts**
78
**What clinical conditions impair fat-soluble vitamin absorption** โ๏ธ
โ ๏ธ **Short bowel syndrome**
โ ๏ธ **Chronic pancreatitis**
โ ๏ธ **Biliary atresia or cholestasis**
79
**Mnemonic to remember fat-soluble vitamins** โ๏ธ
๐
ฐ๏ธโ๐
ณโ๐
ดโ๐
บ
๐ง โADEKโ โ remember theyโre absorbed with **fat** and stored in **liver**
80
**A child with pancreatic insufficiency due to cystic fibrosis is at risk of which vitamin deficiency group** โ๏ธ
A. B-complex
B. Water-soluble
C. Fat-soluble (ADEK)
D. Vitamin C only
๐
**C. Fat-soluble (ADEK)**
## footnote
๐ง Requires fat and enzymes for absorption
81
**What is the earliest symptom of Vitamin A deficiency** โ๏ธ
๐ **Nyctalopia** (night blindness)
82
**What are the major ocular complications of Vitamin A deficiency** โ๏ธ
๐๏ธ **Photophobia**
๐๏ธ **Xerophthalmia**
๐๏ธ **Corneal xerosis** โ **corneal ulceration** โ **keratomalacia**
๐๏ธ **Bitot spots** (foamy patches on conjunctiva)
83
**What systemic effects can result from Vitamin A deficiency** โ๏ธ
๐ **Impaired immune resistance**
๐จ **Higher fatality with measles** in unimmunized children
๐ **Retarded growth**
84
**What are the symptoms of Vitamin A excess** โ๏ธ
๐จ **Pseudotumor cerebri** (increased intracranial pressure)
๐ **Anorexia**
๐ง **Hepatosplenomegaly**
๐โโ๏ธ **Alopecia**
85
**A child with night blindness, Bitot spots, and measles is likely deficient in which vitamin** โ๏ธ
A. Vitamin C
B. Vitamin A
C. Vitamin D
D. Vitamin E
๐
**B. Vitamin A**
## footnote
๐ง Classic features = night blindness + keratinization + infection risk
86
**What is the most common global cause of Vitamin D deficiency** โ๏ธ
๐ **Nutritional deficiency**
## footnote
๐ผ Especially in infants and children with limited sun exposure or poor dietary intake
87
**What are common clinical features of Vitamin D deficiency (Rickets)** โ๏ธ
๐ **Poor growth**
๐ฆต **Muscle weakness, skeletal deformities**
๐ฆท **Delayed teeth formation**
โก **Tetany** (due to hypocalcemia)
88
**Can children with Vitamin D deficiency present asymptomatically** โ๏ธ
โ
**Yes** โ some patients have **no symptoms** , especially early
89
**What are the features of Vitamin D toxicity** โ๏ธ
๐ **Hypercalcemia**
๐ฉ **Constipation**
๐ชจ **Renal stones**
๐ฆด **Myositis ossificans** (abnormal bone formation in muscle)
90
**A child with poor growth, delayed teeth, and muscle weakness is found to have hypocalcemia. What is the most likely diagnosis** โ๏ธ
A. Vitamin C deficiency
B. Vitamin A excess
C. Vitamin D deficiency
D. Iron deficiency
๐
**C. Vitamin D deficiency**
## footnote
๐ง Consistent with classic **rickets features**
91
**What is the primary function of Vitamin E (tocopherol)** โ๏ธ
๐ก๏ธ Acts as a **membrane-bound antioxidant**
โ
Protects cells by **inhibiting free radical damage**
92
**What are common causes of Vitamin E deficiency** โ๏ธ
โ ๏ธ **Biliary atresia**
๐ผ **Very low birth weight premature infants**
๐งฌ **Cystic fibrosis**
๐ฉ Any cause of **fat malabsorption**
93
**What neuromuscular signs are seen in Vitamin E deficiency** โ๏ธ
๐ **Hyporeflexia or areflexia**
๐ถโโ๏ธ **Ataxia**
๐ฃ๏ธ **Dysarthria, dysphagia**
๐๏ธ **Nystagmus** or **ophthalmoplegia** (e.g. canโt look upward)
94
**What cardiac and hematologic features are associated with Vitamin E deficiency** โ๏ธ
โค๏ธ **Cardiac arrhythmias**
๐ฉธ **Hemolytic anemia** , especially in **preterm infants**
95
A premature infant develops hemolytic anemia, nystagmus, and areflexia. Which vitamin deficiency is most likelyโ๏ธ
A. Vitamin A
B. Vitamin C
C. Vitamin D
D. Vitamin E
๐
**D. Vitamin E**
๐ง Neurologic + hematologic findings = classic for **E deficiency**
96
**What is the function of Vitamin K in the body** โ๏ธ
๐งฌ Required for **ฮณ-carboxylation of clotting factors**
โก๏ธ Maintains: **Factor II (prothrombin), VII, IX, X** (2, 7, 9, 10)
97
**What are sources of Vitamin K** โ๏ธ
๐ฅฌ **Dark leafy vegetables** , ๐ฑ **soybean**
๐ฆ **Synthesized by intestinal flora**
98
**What are common causes of Vitamin K deficiency** โ๏ธ
๐ฉ **Fat malabsorption** (e.g. cystic fibrosis, ulcerative colitis)
โ๏ธ **Bowel resection/loss**
๐ **Antibiotic use** (e.g. **cephalosporins** )
๐ผ **Exclusive breastfeeding** (low Vitamin K content)
๐ผ **Home birth without IM Vitamin K**
99
**What is the classic presentation of Vitamin K deficiency in neonates** โ๏ธ
๐ฉธ **Hemorrhagic disease of the newborn**
โ ๏ธ More common in **home-born infants** who did **not receive prophylactic Vitamin K**
100
**What are the key lab findings in Vitamin K deficiency** โ๏ธ
๐งช **Prolonged PT**
๐งช **Normal aPTT**
##Footnote
๐ง Reflects impaired **extrinsic pathway**
101
**How is Vitamin K deficiency prevented and treated** โ๏ธ
โ
**Prophylaxis: 0.5โ1 mg IM Vitamin K at birth**
โ
**Treatment: Vitamin K injection โ Fresh frozen plasma (FFP)** if bleeding is severe
102
**A 4-day-old, exclusively breastfed, home-born infant presents with bleeding and prolonged PT. Whatโs the most likely diagnosis** โ๏ธ
A. Hemophilia A
B. Vitamin C deficiency
C. Vitamin K deficiency
D. Von Willebrand disease
๐
**C. Vitamin K deficiency**
##Footnote
๐ง Classic for **hemorrhagic disease of the newborn**
103
**What is the code for thiamine (B1) deficiency and its manifestation** โ๏ธ
๐ฆ **TB = Thiamine โ Beriberi**
๐ง Think: **โTB = Tuberculosisโ** but here itโs **Thiamine-BeriBeri**
104
**What is the code for riboflavin (B2) deficiency**โ๏ธ
๐ **RC = Riboflavin โ Cheilosis**
๐ง Mnemonic: **โRC = Root Canalโ**
105
**What is the code for niacin (B3) deficiency**โ๏ธ
๐ฅ **NP = Niacin โ Pellagra**
๐ง Think: **โNP = No Problemโ** (but Pellagra is a problem!)
106
**What is the code for pantothenic acid (B5) deficiency** โ๏ธ
๐ฅ **5BFS = 5 = Burning Feet Syndrome**
๐ง Think: **โ5 Best Friends Sizzleโ**
107
**What is the code for pyridoxine (B6) deficiency** โ๏ธ
๐ป **PCAD = Pyridoxine โ Convulsions, Anemia, Dermatitis**
๐ง Mnemonic: **โPersonal Computer And Deviceโ**
108
**What is the code for biotin (B7) deficiency** โ๏ธ
๐ซ **BAD = Biotin โ Anorexia, Dermatitis**
109
**What is the code for folic acid (B9) deficiency** โ๏ธ
๐ง **FANT = Folic acid โ Anemia, Neural tube defect**
110
**What is the code for cobalamin (B12) deficiency** โ๏ธ
๐ง **CAN = Cobalamin โ Anemia, Neuropathy**
111
**What is the code for ascorbic acid (Vitamin C) deficiency** โ๏ธ
๐ฉธ **AS = Ascorbic acid โ Scurvy**
112
113
What deficiency does the mnemonic FANT representโ๏ธ
A. Folic acid โ Neural tube defects
B. Thiamine โ Ataxia
C. Biotin โ Convulsions
D. Vitamin A โ Night blindness
๐
**A. Folic acid โ Neural tube defects**
## footnote
๐ง FANT = Folic Acid โ Anemia + Neural Tube defect
114
**At what age does iron deficiency commonly peak** โ๏ธ
๐ Between **6โ20 months** of age
115
**When should screening for iron deficiency be done in children** โ๏ธ
๐ฉบ At **1 year** and **2 years**
116
**What are the common clinical signs of iron deficiency anemia in children** โ๏ธ
๐ **Growth retardation**
๐ฆ **Increased susceptibility to infections**
๐ก **Irritability**
๐ **Stomatitis and glossitis**
๐ง **Pica** (eating non-food items)
๐ **Lower IQ scores, decreased school performance**
117
**A 1-year-old with pica, glossitis, and poor school readiness likely has which deficiency** โ๏ธ
A. Zinc
B. Iron
C. Vitamin B12
D. Folate
๐
**B. Iron**
##Footnote
๐ง Classic for iron deficiency anemia in toddlers
118
**What are common causes of zinc deficiency** โ๏ธ
โ ๏ธ **Malabsorption**
๐ฅฃ **Low nutritional intake**
๐ฉ **Excess loss** (e.g. **chronic diarrhea** )
119
**What are the classic clinical features of zinc deficiency** โ๏ธ
๐ **Alopecia**
๐ฉ **Diarrhea**
๐งด **Dermatitis**
๐ฆ **Frequent infections** (due to **T-cell dysfunction** )
๐ **Failure to thrive (FTT)**
๐
**Loss of taste (hypogeusia)**
๐ **Low alkaline phosphatase**
120
**What is acrodermatitis enteropathicaโ๏ธ**
๐งฌ **Autosomal recessive** inherited **zinc transport defect**
121
**When does acrodermatitis enteropathica typically present** โ๏ธ
๐ถ Shortly **after weaning** from **breastfeeding**
122
**What are the key features of acrodermatitis enteropathica** โ๏ธ
๐ป **Acral dermatitis** (mouth, anus, extremities)
๐ป **Erythematous scaly skin**
๐ **Alopecia**
๐ฉ **Refractory diarrhea**
123
**An infant presents with perioral dermatitis, alopecia, and persistent diarrhea after weaning. What is the most likely diagnosis** โ๏ธ
A. Iron deficiency
B. Vitamin A deficiency
C. Acrodermatitis enteropathica
D. Biotin deficiency
๐
**C. Acrodermatitis enteropathica**
## footnote
๐ง Genetic zinc transport defect
124
**In what type of patients does refeeding syndrome typically occur** โ๏ธ
โ ๏ธ **Severely malnourished** patients receiving **artificial refeeding**
125
**What is the key electrolyte abnormality in refeeding syndrome** โ๏ธ
๐ **Severe hypophosphatemia**
๐ง Due to sudden **cellular uptake of phosphate**
126
**What triggers the metabolic shift in refeeding syndrome** โ๏ธ
๐ **Hyperglycemia** โ **increased insulin secretion**
โก๏ธ Drives **K+, Mg2+, PO4ยณโป** into cells โ **electrolyte depletion**
127
**What other electrolyte disturbances may occur in refeeding syndrome** โ๏ธ
๐ **Hypokalemia**
๐ **Hypomagnesemia**
๐ **Hypocalcemia**
128
**What complications can result from phosphate and electrolyte shifts in refeeding syndrome** โ๏ธ
โ ๏ธ **Arrhythmias, respiratory failure, neurologic symptoms**
๐ง Also: **edema** , **fluid retention** , and **thiamine deficiency**
129
**A malnourished patient started on total parenteral nutrition develops weakness, edema, and hypophosphatemia. What is the most likely diagnosis** โ๏ธ
A. SIADH
B. Tumor lysis syndrome
C. Refeeding syndrome
D. Addisonโs disease
๐
**C. Refeeding syndrome**
๐ง Key = **electrolyte shift** + **PO4 depletion** after refeeding
130
**What are the key criteria used to define Failure to Thrive (FTT)** โ๏ธ
๐ **Weight <3rd or 5th percentile on weight-for-length chart**
๐ **Drop of โฅ2 major percentile lines**
๐ **Weight <80% of ideal weight for age**
## footnote
๐ Importance: **Always assess weight, height, and head circumference on growth charts**
131
**What is the most common cause of FTT** โ๏ธ
โ ๏ธ **Non-organic causes** (95%) โ often due to **environmental and psychosocial factors**
##Footnote
๐ง MNEMONIC: โThere are Numerous Reasons I am Failing to Thriveโ
๐ฉบ T โ Thyroid/Type 1 DM
๐ฆ N โ Neglect/Nutritional deficiency
๐ง R โ Reflux
๐งฌ I โ Immunodeficiency/IBD
๐ซ F โ Heart failure/Congenital disease
๐ง T โ Tumor or intracranial causes
132
**What are medical conditions associated with FTT** โ๏ธ
๐ป **GERD**
๐ป **Malrotation with volvulus**
๐ป **โ Intracranial pressure**
๐ป **Celiac disease (>6 months)**
๐ป **Chronic illness** (CHF, CKD, endocrine disorders)
๐ป **Milk protein intolerance**
๐ป **Child abuse/neglect**
133
**What are the 3 main mechanisms contributing to FTT** โ๏ธ
1๏ธโฃ **Inadequate intake** โ e.g., poor breastfeeding, cleft palate
2๏ธโฃ **Increased metabolic demand** โ e.g., CHF, hyperthyroidism
3๏ธโฃ **Increased losses** โ e.g., diarrhea, vomiting, malabsorption
134
**What tests are used in evaluating a child with FTT** โ๏ธ
๐ฌ **CBC, CMP**
๐ฌ **Celiac screen (IgA + anti-TTG-IgA)**
๐ฌ **Stool fat & reducing substances**
๐ฌ **Sweat chloride (for cystic fibrosis)**
๐ฌ **TSH + Free T4, urinalysis**
135
**What are indications to hospitalize a child with FTT** โ๏ธ
๐จ **Severe malnutrition**
๐จ **Medical instability**
๐จ **Outpatient failure**
๐จ **Evidence of abuse/neglect**
๐จ **Disordered parent-child interaction**
136
**What are key goals in the management of FTT** โ๏ธ
โ
Improve **nutritional quantity and quality**
โ
Treat **underlying causes**
โ
Address **behavioral feeding problems**
โ
Involve **occupational therapy** if needed
137
138
**What is the pediatric equivalent of osteomalacia in adults** โ๏ธ
๐ฆด **Rickets** โ defective mineralization of **growing bones**
139
**What are common causes of Rickets** โ๏ธ
๐ผ **Exclusive breastfeeding** without **vitamin D supplementation** and minimal sun exposure
๐ฉ **Fat malabsorption** (e.g., celiac, CF)
๐งฌ **Liver/kidney disease**
๐ **Anticonvulsants** (e.g., phenobarbital, phenytoin)
๐งฌ **Genetic defects**
140
**What are key clinical features of Rickets** โ๏ธ
๐ป **Craniotabes** (soft skull bones)
๐ป **Frontal bossing**
๐ฆด **Rachitic rosary** (costochondral beading)
๐ฆต **Bowing of legs**
๐ถ **Delayed walking, delayed fontanelle closure**
141
**What are radiologic features of Rickets** โ๏ธ
๐ **Widened, cupped, and frayed metaphyses**
๐ฆด **Osteopenia**
๐ซ **Delayed bone age**
๐ก Classic site: **distal radius and ulna**
142
**What is the treatment for nutritional Rickets** โ๏ธ
โ
**Vitamin D supplementation**
โ
**Calcium replacement**
โ
**Sunlight exposure**
143
**A child presents with bowed legs, rachitic rosary, and widened metaphyses. Whatโs the most likely diagnosis** โ๏ธ
A. Scurvy
B. Osteogenesis imperfecta
C. Rickets
D. Lead poisoning
๐
**C. Rickets**
## footnote
๐ง Classic for **vitamin D deficiency in children**
144
145
**What is the mnemonic for clinical presentation of Rickets**โ๏ธ
๐ง **โRICKETSโ**
๐ธ **R** = Rachitic rosary
๐ธ **I** = Pigeon chest
๐ธ **C** = Craniotabes
๐ธ **K** = Knock knees
๐ธ **E** = End of long bones widen
๐ธ **T** = Teeth delayed eruption & enamel hypoplasia
๐ธ **S** = Skull frontal bossing & delayed fontanelle closure
146
**What are the classic lab findings in nutritional Rickets**โ๏ธ
๐ **Calcium** : Low to normal
๐ **Phosphorus** : Low
๐ **Alkaline phosphatase** : High
๐ **Parathyroid hormone** : High
147
**What are key X-ray features in Rickets** โ๏ธ
๐ฆด **Widened, irregular epiphyseal plate**
๐ฆด **Cupping, splaying, fraying** of metaphysis
๐ฆด **Osteopenia**
โ
Best sites: **Knee (AP view)** , wrist, ankle
148
**What is the treatment plan for nutritional Rickets** โ๏ธ
๐น **Vitamin D** :
โ Daily dose: **1,000โ10,000 IU** for 2โ3 months
โ Maintenance: **400 IU/day** after radiologic healing
๐น **Calcium** supplementation
๐น **Monitor labs & X-ray** in **3 months**
๐น โIf no healing: investigate **rare causes of Rickets**
149
**A child presents with bowing of the legs, rachitic rosary, and frayed metaphysis. Labs show high ALP and PTH, low phosphorus. What is the most likely diagnosis** โ๏ธ
A. Vitamin C deficiency
B. Nutritional Rickets
C. Osteogenesis imperfecta
D. Scurvy
๐
**B. Nutritional Rickets**
## footnote
๐ง Labs + bone X-ray changes = classic for vitamin D deficiency
150
**What is the inheritance pattern of hypophosphatemic rickets** โ๏ธ
๐งฌ **X-linked dominant**
๐ฆ๐ง Affects **both males and females**
151
**What are the typical features of hypophosphatemic rickets in children**โ๏ธ
๐ **Failure to thrive**
๐ **Hypotonia**
๐ซ **Inability to bear weight** (when standing/walking)
๐ฆท **Delayed dentition**
๐ฆต **Widened intercondylar distance** (>6 cm = pathological)
152
**What lab abnormalities are seen in hypophosphatemic rickets** โ๏ธ
โ
**Calcium** : Normal
๐ **Phosphorus** : Low
๐ **Alkaline phosphatase** : Very high
โ ๏ธ **Low phosphorus** may be missed if adult reference ranges are used!
153
**What are the radiological findings in hypophosphatemic rickets** โ๏ธ
๐ฉป Same as **vitamin D deficiency rickets** :
โ Cupping, fraying, widening of metaphyses
โ Osteopenia
154
**What is the treatment for X-linked hypophosphatemic rickets** โ๏ธ
๐ **Calcitriol (active vitamin D)**
๐ **Phosphorus supplementation**
155
**A child with normal calcium, low phosphate, bow legs, and high ALP is diagnosed with** โ๏ธ
A. Nutritional Rickets
B. Osteogenesis Imperfecta
C. X-linked Hypophosphatemic Rickets
D. Scurvy
๐
**C. X-linked Hypophosphatemic Rickets**
## footnote
๐ง ๐ต๏ธ = low phosphate + normal calcium + very high ALP
156
**What is the core psychopathology in anorexia nervosa**โ๏ธ
๐ง **Distorted body image** despite being underweight
โ๏ธ **Persistent behaviors to lose weight** despite emaciation
157
**What are classic physical findings in anorexia nervosa**โ๏ธ
โ๏ธ **Cold intolerance, fatigue, bradycardia, hypothermia**
๐ฆ **Lanugo hair, dry skin, amenorrhea, low glucose**
158
**What metabolic state characterizes anorexia nervosa** โ๏ธ
๐ **Hypometabolic** โ reduced caloric intake and slowed physiolog
159
**How does bulimia nervosa differ from anorexia** โ๏ธ
๐ฝ๏ธ **Recurrent binge eating** + **compensatory behaviors** (vomiting, laxatives)
๐ง **Variable body image distortion**
๐ Not necessarily underweight
160
**What physical exam findings suggest bulimia nervosa** โ๏ธ
๐๏ธ **Subconjunctival hemorrhages**
๐ฆท **Dental enamel erosion**
๐ฆ **Salivary gland enlargement**
161
**What labs are typically seen in bulimia nervosa**โ๏ธ
๐งช **Hypokalemic, hypochloremic metabolic alkalosis**
๐ **Elevated cortisol, cholesterol, liver enzymes**
๐ **Low gonadotropins, low glucose**
162
**What causes refeeding syndrome in eating disorders**โ๏ธ
โก **Rapid reintroduction of calories** (esp. carbs)
๐ Leads to **hypophosphatemia, hypokalemia, hypomagnesemia**
๐จ Results in **heart failure, tachycardia, neurological decline**
163
**What are critical indicators requiring hospitalization in eating disorders**โ๏ธ
โค๏ธ **HR <50 bpm, arrhythmias, BP <80/50 mmHg**
๐ง **Body temp <36.1ยฐC**
๐งช **Hypokalemia, hypophosphatemia, hypoglycemia**
๐ง **Suicidality, organ compromise, or poor motivation to recover**
164
**What is the mainstay treatment for eating disorders** โ๏ธ
๐ง **Cognitive Behavioral Therapy (CBT)**
๐ **SSRIs** as adjunctive treatment
165
**A thin teen girl with bradycardia, lanugo, and dry skin feels fat. Labs show hypoglycemia. What is the diagnosis** โ๏ธ
A. Bulimia nervosa
B. Anorexia nervosa
C. Binge-eating disorder
D. Refeeding syndrome
๐
**B. Anorexia nervosa**
## footnote
๐ง Hallmark: persistent calorie restriction + distorted body image
166
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