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Ped Board Study > Nutrition > Flashcards

Nutrition Flashcards

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1
Q

What is the name of the whitish keratin debris that can be found near the limbus of the eye? What deficiency?

A

Bitot spot - Vitamin A

  • This is a medical emergency (any corneal clouding) and requires large parenteral doses of Vit A.

Memory tool: Mom said eat your carrots they help your eyes “Carrots have carotene which converts into Vit A.”

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2
Q

Signs of Vit A deficiency

A

Poor night vision (and bitot spots, keratinized plaques)
Dry skin (hyperkeratosis patches), hair, and nails
Conjunctival Xerosis (dry)
Inc susceptibility to resp and GI illness
Blindness, if left untreated

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3
Q

Signs of Vit E deficiency; What are some common disorders associated with Vit E deficiency?

A

Neurologic dysfunction esp neuroaxonal degeneration and loss of reflexes
Premature infants can have hemolytic anemia if Vit E def.

Common in children with fat malabsorption issues like: pancreatic insufficiency as in cystic fibrosis and liver disease

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4
Q

Premature infants can present with hemolytic anemia if deficient in this Vitamin.

A

Vitamin E

(Hemolytic anemia and neurologic deficits)

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5
Q

What does acrodermatitis enteropathica look like?

A

It has an appearance similar to SSSS. Appears on face most often and buttocks.

Staged changes:
vesiculobullous lesions on intensely erythematous base –> bullae repture leaving moist, ertyhematous lesions –> Crust over to scaly/eczematoid appearance (location: perioral, checks, extensor surfaces, diaper area)

(Zinc deficiency – can be seen in CF or other malabsorption illnesses)

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6
Q

Zinc deficiency results in (5)

A

Acrodermatitis enteropathica
Diarrhea
Hair loss
Impaired immunity
Hypogeusia (aka reduced taste)

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7
Q

What is one purpose of replacement pancreatic enzymes for someone with cystic fibrosis?

A

Aids in release of enzymes that support fat absorption and absorption of F_AKED vitamins

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8
Q

What are the vit k dependent clotting factors?

A

2, 7, 9, 10

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9
Q

What vitamin is synthesized within the body? Where?

A

Vitamin K is synthesized by intestinal flora in the gut AND ingested in the diet (leafy greens, broccoli, cauliflower, soybeans)

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10
Q

Beriberi is what deficiency?

A

Vitamin B1 - Thiamine

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11
Q

Rickets is what deficiency?

A

Vitamin D

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12
Q

Scurvy is what deficiency

A

Vitamin C

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13
Q

Symptoms of scurvy

A

Vit C deficiency

Gingival bleeding
Petechiae
Ecchymosis
Poor wound healing
Swelling & tenderness of lower extremities
Curly corkscrew coiled hair

Bone fracture and brittle x-ray findings: metaphyseal zone of tubular bones has a dense band of white (provisional calcification), called the White line of frankel and at the sternal-rib junction

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14
Q

Symptoms of beriberi

A

Thiamine (Vitamin B1) deficiency

peripheral neuritis
Decreased deep tendon reflex
loss of vibratory sensation
LE muscle cramping and tenderness
HF
psych symptoms

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15
Q

Symptoms of Riboflavin (Vit B2) deficiency

A

Cheilosis
Glossitis
Conjunctivitis with photophobia
Seborrheic dermatitis

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16
Q

Symptoms of Pyridoxine deficiency (B6)

A

Vomiting
Lethargy
FTT
irritability
seizures

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17
Q

Bowed legs seen in

A

Vit D deficiency

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18
Q

Clinical findings of widening of the wrist and knees and bone pain seen in

A

Vit D deficiency

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19
Q

X-ray findings of enlarged costochondral junctions (known as rachitic rosary) seen in

A

Vit D deficiency

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20
Q

Daily Nutritional Requirements by age group (need to memorize). Age 1-3

A

Energy: 1000 kcal/day
Protein 13 g/day
Fat 30-40 g/day

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21
Q

Rank the 3 main types of nutrition by density. Kcals/g?

A

Fats (most dense): 9 kcal/g
Carbs & Proteins: 4 kcal/g

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22
Q

Daily Nutritional Requirements by age group (need to memorize). Age 4-8

A

Energy: 1200-1400 kcal/day
Protein: 19 g/day
Fat: 25-35 g/day

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23
Q

Daily Nutritional Requirements by age group (need to memorize). Age 9-13M / F

A

Energy: 1600-2000 kcal/day (M) 1400-1600 kcal/day (F)
Protein: 34 g/day
Fat: 25-35 g/day

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24
Q

Daily Nutritional Requirements by age group (need to memorize). Age 14-18M / F

A

Energy: 2000-2400 kcal/day (M) / 1800 kcal/day (F)
Protein: 52 (M) / 46 (F) g/day
Fat: 25-35 g/day

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25
X-ray findings: "Ground glass appearance" on long bone (meaning a white line of calcification surrounding the epiphyseal centers)
AKA wimberger ring or a white line of frankle along tubular bones Vit C deficiency (other findings: Gingival swelling, petechiae, hyperkeratosis of hair, purpura, irritability, poor appetite, generalized tenderness)
26
Osteochondritis at metaphysis
Widens the zone of provisional calcification until there is epiphyseal separation Seen in Congenital syphilis
27
Progressive cortical thickening with swelling of the bone shafts of cortical bones
Infantile cortical hyperostosis aka Caffey Disease periosteum is involved which sometimes is confused for NAT
28
Irritability, lethargy, HA, abdominal pain X-ray findings of long bon with opaque, transverse, dense metaphyseal bands that appear in growing tubular bones
Lead poisoning lead lines (where growth is arresting) don't appear until BLL 70-80 mg/dl
29
What is the daily basal kcal requirements calculation?
Holliday-Segar formula for basal nutrition: 100 kcal/kg for first 10 kg PLUS 50 kcal/kg for next 10 kg PLUS 20 kcal/kg for rest of the weight
30
What is the daily maintenance fluid requirements calculation?
Holliday-Segar formula for maintenance IVF: 4-2-1 4 ml/h for first 10 kg PLUS 2 ml/h for next 10 kg PLUS 1 ml/h for rest of the weight
31
Physical exam findings of: Mild dehydration (3) Treatment PER med study (how much?)
Dry mucous membranes Oliguria weight loss 5% Oral rehydration solution at 50-60 ml/kg
32
Physical exam findings of: Mod dehydration (6) Treatment PER med study (how much?)
Market oliguria Poor skin turgor sunken fontanelle tachycardia irritability weight loss 10% Oral rehydration solution at 80-100 ml/kg
33
Physical exam findings of: Severe dehydration (4)
Hypotension Poor perfusion Lethargy weight loss 15% (And findings of mod dehydration) IV rehydration at 40 ml/kg/h (aka 2x 20 ml/kg boluses) until pulse and mentation normalize then oral rehydration
34
Will an infant with cow's milk protein (CMPI) tolerate a soy formula?
Maybe. Up to 50% of infants with a rxn to cow's milk protein demonstrate an allergy to soy protein as well.
35
Can a preterm infant with CMPI get soy formula?
Per Med study books, soy formulas are NOT recommended in preterm infants due to increased risk of osteopenia and poorer weight gain (vs cow's milk based formulas).
36
What type of formula is recommended if an infant suffers from reflux on cow's milk formula?
Soy formula show no proven value over cow's milk. Trial a hydrolyzed (hypoallergenic) formula.
37
What are 6 key things transferred in breastmilk (other than carbs, fats, proteins)?
Immunoglobulins, Immune-modulating factors Hormones Growth factors Enzymes Cholesterol
38
What is the AAP's breastfeeding recommendation?
Exclusive for first 6 months. Continued with introduction of foods at 6 months, for 2 years or more, as desired by parent and child. Recommended through 1 year.
39
Breastfeeding is associated with which of the following decreases in pediatric illnesses (9 to know)
Decreased rates of: Otitis media Acute diarrheal illness LRI SIDS & Infant mortality IBD Celiac Childhood leukemia Asthma Atopic dermatitis * Also, potentially protective against obesity and DM in childhood, teens, and adults * Also, potentially favorable neurodevelopmental outcomes with longer breastfeeding durations
40
Breastfeeding is associated with which of the following decreases in the breastfeeding parent (7 to know)
Reductions in risk of: T2DM Hyperlipidemia HTN Osteoporotic fracture Breast cancer Ovarian Cancer Endometrial Cancer
41
How does breastmilk from mothers of preterms infants different from term infants? At what age do preterm infant nutrition needs surpass the contents of breastmilk?
Preterm mother milk usually has higher concentrations of fat and protein than term. Preterm infants require (100-150 kcal/kg/d) vs term infants (100-120 kcal/kg/d) and by 1 month of age have additional nutritional needs that surpass contents of milk (like certain vitamins, total protein content, certain minerals, and electrolytes). This is why breastmilk for a preterm infant should be FORTIFIED.
42
What specific nutritional deficits are expected complications in preterm infants and at what age? (4 specific)
Hyponatremia at 4-6 weeks Hypoproteinemia at 8-12 weeks Zinc deficits at 8-24 weeks Osteopenaia (Ca+ and ....?) at 16 weeks
43
Oxytocin leads to ____ in new breastfeeding parent. Pitocin leads to ____.
Oxytocin - let down Pitocin - production Adequate breast drainage maintains pitocin. Oxytocin + Milk ejection reflex occur in response to suckling
44
Colostrum is rich in ___ and ____
Antibodies and fat
45
What diseases are absolute contraindications (2) or relative contraindications (2) to breastfeeding?
Absolute: HIV, GALT deficiency in the infant Relative: G6PD infant - parent must avoid Macrobid, Primaquine, Phenazopyridine, Fava beans CMPI - parent must avoid milk (dairy) product
46
What medications are absolute contraindications to breastfeeding (5)?
Amphetamines Chemotherapy Agents Ergotamines Statins Iso-t-retinoin (insufficient data, so recommended to avoid oral) * Also Tchn-99m contrast excretes in BM and cessation for a period to allow clearing is required.
47
Vegans need to supplement these vitamins and minerals (5)
B12 (source is primarily meat, eggs, dairy) -- do so with nutritional yeast, fortified cereal, or other [Megaloblastic, elevated MCV anemia] Iron -- non heme iron from plants isn't absorbed as well; eat with Vit C as they help each other with absorption [Microcytic anemia] Calcium --do so with fortified non-dairy milks and juices Zinc Vit D
48
What vitamin deficiencies have been seen in infants taking goat's milk?
Vit B6 and Folate (B9)
49
What is the dose to treat Vit D deficiency in children and adolescents?
600 IU/day
50
When do infant iron store fall off? Do you need to supplement iron at this time? What is the dose for a term infant? preterm infant?
6 months of age. If exclusively breastfed, or combo fed, should begin daily iron supplementation of 1 mg/kg of elemental iron.d around 4-6 months until food provides enough of this nutrient. Otherwise, it is included in fortified formulas. If preterm or low birth weight, 2 mg/kg/d beginning at 1 month until 12 months for breastfed and 1 mg/kg/d for formula fed (in addition to fortified formula). Between 6-12 mo the requirement is 11 mg/d (preferred through iron rich foods)
51
Lab findings in IDA
'May show' - low Hgb, low serum iron, low ferritin, elevated TIBC and/or erythrocyte protoporphyrin Blood smears show - small RBCs (microcytic) with central pallor (hypochromic)
52
Why do kids who drink too much cow's milk often have IDA?
Iron in cow's milk has less bioavailability than other sources like heme iron from meat. They therefore displace better food sources of iron. Iron absorption is enhanced by Vit C.
53
Why are infants <1 year at risk for botulinum from honey?
They gut is microbiome is not well developed enough to manage c. botulinum spores
54
How many ounces of whole milk is appropriate for a 12-24 month old? How many ounces in 2-5 yo? What type of milk What is the recommended limit for fruit juice in 1-3 yo and 4-5 yo?
16-24 oz / day whole milk (0-2 yo) 16-24 oz / day 1%, 2%, skin (2-5 yo) <= 4 oz / day for 1-3 yo, juice 4-5 oz / day for 4-5 yo, juice 0 sugary, sweetened or caffeinated beverages in < 5 yo
55
What electrolyte imbalances are seen in refeeding syndrome? How does this happen?
Hallmark: Hypophosphatemia Hypokalemia, Hypomagnesemia, Hyponatremia Reintroduction of carbohydrates after starvation release insulin and triggers cellular uptake of K+, Mg+, Po43- Typically treat with: K and Phos repletion
56
Severe malnutrition is historical placed into two categories. Define
Kwashiorkor (protein) now known as protein-energy malnutrition with EDEMA. Remember: edema, liver enlargement (due to fatty infiltrates), characteristic desquamation of epidermis and rash, increased risk of infection Marasmus (calorie) now known as protein-energy malnutrition without edema. Remember: cachectic, lack of subcutaneous fat, prolonged have hypothermia, bradycardia, and hypotension at baseline
57
Children with this vitamin deficiency are at higher risk for severe measles?
Vitamin A
58
What are the key symptoms of excessive vitamin A?
Idiopathic intracranial hypertension (formerly pseudotumor cerebri) Bone pain Muscle pain Cortical hyperostosis Hepatomegaly Scaly skin (different from hyper keratinized skin)
59
Symptoms of Vit D deficiency (Rickets)
Poor growth, skeletal deformities, bony tenderness, dental deformities, muscle cramps, hypocalcemia, hypophosphatemia, poor growth, tetany, delayed development
60
Keep skeletal deformities seen in rickets (includ x-ray fidings)
Bowed legs Enlargement of costochondral joints in the rib cage (rachitic rosary) Scoliosis or kyphosis Delayed teeth eruption Pelvic deformities osteopenic shafts widened growth plates fraying cupping/uneven blurred ends
61
Lab findings in Vit D deficiency rickets?
Low 25-OH D (circulating Vit D) Decreased Ca (or normal early on) Decreased phos (or normal early on) Increased PTH (indicates an intact hormonal axis trying to respond to low Vit D, rather than PTH low seen in an underlying genetic disorder causing low Vit D)) Increased alk phos 1-25-OH(2)-D has a short half life and is not a good indicator (can be high, low, or normal)
62
If Vit D or Rickets is diagnosed, what is the dosage of Vit D treatment? 0 - 12 mo >12 mo - 12 yo > 12 yo
0-12 mo: 2000 IU for 90 d >12 mo - 12 yo: 3000-6000 IU for 90 d > 12 yo: 6000 IU for 90 d
63
What is the second most common nutritional cause of anemia (after IDA)?
Folate deficiency anemia (B9)
64
Folate deficiency in pregnant person can cause
Neural Tube Defects
65
Symptoms of Vit E deficiency
Hemolytic anemia Neurologic deficits
66
What should vegan mothers do (for them or for baby) to ensure their infant doesn't have nutritional deficits if breastfeeding?
They should supplement infant with Vit D (400 IU) like all breastfed infants and with Iron once they are 4-6 months old, like all breastfed infants. Add a B12 supplement for Mom and Baby. (because Vegan)
67
B3 is also known as ____. Deficiency is called ____. Signs / symptoms?
B3 = Niacin Deficiency is called pellagra. 3 Ds - diarrhea, dermatitis, long term? = dementia
68
B2 is also known as ___. Signs / symptoms?
Riboflavin Cheilosis and sore tongue
69
B1 is also known as ___. Deficiency is called ___. Signs / symptoms?
B1 = Thiamine Deficiency is called beriberi. Foot and wrist drop, paraesthesias, peripheral neuritis including muscle atrophy, loss of DTR Can lead to wernicke's encapholpathy - ophthalmoplegia, ataxia, confusion
70
If infants have sz responsive to B6, think of these two causes for the seizure.
1. Metabolic defect 2. Isoniazid overdose
71
B12 is also known as ___. Deficiency signs/symptoms?
Cobalamin. Megaloblastic anemia. Most common cause in children: ileal disease of some sort (Crohn's leading to short bowel syndrome due to resection)
72
Describe the rash associated with Kawashiorkor malnutrition:
blanching erythema overlying reddish-brown scaling sharply demarcated raised edges
73
What does Vitamin D promote in the Kidney? Intestine? Bone?
Kidney: Stimulates reabsorption of Ca and phosphate Intestine: increase absorption of Ca and phosphate Bone: Promotes resorption of old bone (release of Ca and Phos) for reuse

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