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117 Cards in this Set

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Vitamin A is aka...

Eyes
Retinol
Eyes
Vitamin E is aka...

Discovered by Mrs. Evans "to bear young" "Talk of Errol"
Tocopherol
Discovered by Mrs. Evans "to bear young" "Talk of Errol"
Vitamin K is aka...

Queen of Phyllo bread holds it all together
Phylloquinone
Queen of Phyllo bread holds it all together
Vitamin B1 is aka...

Thigh man
Thiamine
Thigh man
Vitamin B2 is aka...

We have 2 sets of ribs
Riboflavin
We have 2 sets of ribs
Vitamin B3 is aka...

It was originally used in the oxidation of nicotine, which is integral to three pack-day smokers.
Niacin. It was originally used in the oxidation of nicotine, which is integral to three pack-day smokers.
It was originally used in the oxidation of nicotine, which is integral to three pack-day smokers.
Vitamin B5 is aka...

Think "pento"
Pantothenic Acid
Think "pento"
Vitamin B6 is aka...

It paradoxically prevents peripheral neuropathy due to INH in TB treatment
Pyridoxine. It paradoxically prevents peripheral neuropathy due to INH in TB treatment
It paradoxically prevents peripheral neuropathy due to INH in TB treatment
Vitamin B9 is aka...

It is needed in pregnancy to prevent neural tube defects and anemia
Folate. It is needed in pregnancy to prevent neural tube defects and anemia
It is needed in pregnancy to prevent neural tube defects and anemia
Vitamin B12 is aka...

It's blue...or the C in CMYK inks
Cyanocobalamin
It's blue...or the C in CMYK inks
Vitamin C is aka...

"antiscorbutic" acid
Ascorbic Acid
"antiscorbutic" acid
Biotin is aka...
Biotin

Trick Question!
Trick Question!
What is effect of Vitamin A deficiency?
Xeropthalmia: First there is dryness of the conjunctiva (xerosis) as the normal lacrimal and mucus secreting epithelium is replaced by a keratinized epithelium. This is followed by the build-up of keratin debris in small opaque plaques (Bitot's spots) and photophobia and eventually, erosion of the roughened corneal surface with softening and destruction of the cornea (keratomalacia) and total blindness
What is Beri Beri?
B1 deficiency. Weakness, confusion, tachycardia, cardiomegaly, peripheral paralysis

Thigh Man falls down, becomes confused, and his heart races
Thigh Man falls down, becomes confused, and his heart races
What is effect of Vitamin A toxicity?
Pseudotumor Cerebri
High ICP and the eye.
High ICP and the eye.
What is the effect of Riboflavin deficiency?

oral-ocular-genital syndrome
Angular stomatitis, Anemia, Seborrheic Dermatitis, Photophobia
oral-ocular-genital syndrome
Why do we give premies phototherapy only every 12 hours?
Because phototherapy gobbles up the riboflavin.

Preemie wearing dark sunglasses under a tanning bed.
Preemie wearing dark sunglasses under a tanning bed.
What is Pellagra?
Niacin (B3) Deficiency: Diarrhea, Dermatitis, Dementia, Glossitis
Also known as Vitamin PP deficiency.
What are the effects of Niacin (B3) toxicity?
Vasodilation
What is the effect of pyridoxine (B6) deficiency?
Irritability, convulsions, hypochromic anemia; peripheral neuritis in patients receiving isoniazid; oxaluria
It is paradoxical
What is the effect of Niacin (B3) toxicity?
Sensory neuropathy (in adults)
It is paradoxical
What is the effect of folate (B9) deficiency?
Megaloblastic anemia (infancy, pregnancy) usually is secondary to malabsorption disease, glossitis, pharyngeal ulcers, impaired immunity

Treatment with this may mask deficiency of B12
Treatment with this may mask deficiency of B12
What is the effect of cyanocobalamin (B12) deficiency?
Juvenile pernicious anemia, due to defect in absorption rather than to dietary lack
What are effects of Vitamin C deficiency?
Leg tenderness, poor wound healing scurvy: liver spots on the skin, spongy gums, and bleeding from mucous membranes. X-ray shows cortical thinning in legs and arms.

Christopher Columbus gave his men lemons to build collagen.
Christopher Columbus gave his men lemons to build collagen
What is the effect of Vitamin C toxicity?
Excessive doses can cause oxalate and cysteine nephrocalcinosis. It is excreted from the kidneys
It is excreted from the kidneys
In a patient with glucose 6 phosphate dehydrogenase deficiency, what happens if they take too much Vitamin C?
Hemolytic crisis
What is the effect of Vitamin E deficiency?
Hemolytic anemia in preemies and neurological damage in older kids
What is the effect of Vitamin K deficiency?
Hemorrhagic disease of the newborn because Vitamin K does not cross the placenta and the newborn can't make it because the gut flora is not well established and it is an essential fat soluble vitamin.
Remember that newborns get a shot of this at birth.
Do breast fed babies need Vitamin K?
Yes. Breast milk does not contain much Vitamin K
A child is born at home on a farm and is breast fed exclusively. She is brought to you, the only pediatrician in town because she has been having uncontrollable epistaxis. What are your two next steps?
Vitamin K then FFP
What are the Vitamin K dependent clotting factors?
Factor 2, 7, 9, 10
A 2 year old is brought to you because his mom has noticed he is yellow. His eyes and mouth are not yellow. What do you do next?
Change his diet. Do not "get a bili"
A teenager comes to you complaining acne and her friend uses Retin A (Isoretinoin). Before you prescribe this for her what must you check?
Pregnancy Test
How does Vitamin D Toxicity work? How do you treat it?
It mobilizes calcium and phosphorus and causes nausea, vomiting and then weakness, because calcium and phos deposit in soft tissue.

Causes polyuria, polydipsia, increased BUN, nephrolithiasis and ARF.
Similar symptoms like diabetes
Vitamin D2 is aka...
Ergocalciferol
Vitamin D3 is aka...
Cholecalciferol
25 Hydroxy-Vitamin D is aka...

Where is it?
Calcidiol

Hydroxylated in liver (only one liver)
1,25 hydroxycalciferol is aka...

Where is it?
Activated Calcitriol which is hydroxylated in the kidney
A mom comes to you and says she would like to raise her son as a vegan. She read that as long as her son is exposed to the sun, he does not need dietary Vitamin D. Is this true?
Yes.
How do you diagnose rickets?

What are x-ray findings?
Low 25-OH-vitamin D and high PTH with extremely HIGH ALK PHOS!

wide wrists with metaphyseal cupping or flaring of long bones.
Are calcium and phosporus low, high or normal in rickets?
They could be anything, even normal.
In chronic liver disease, what is the pathophysiology of rickets?
There is reduced availability of bile salts, in the gut and thus a decreased absorption of vitamin D.
What is the normal function of Vitamin D?
Vitamin D assists in Calcium absorption from the gut so it can go to the bones and it helps kidneys balance phosphorus and calcium.
What does low Vitamin D do physiologically?
It allows PTH to go unchecked, resulting in increased bone destruction, and increased phosphorus excretion in kidneys and potentially high serum calcium.
What is acrodermatitis eteropathica?
Zinc Deficiency
A 2-year-old African-American boy is brought to you for a routine visit. He was exclusively breastfed until 1 year of age, and has been a poor feeder since then.
His height and weight are less than the 5th percentile. His legs are slightly bowed, and he has frontal bossing. He has no teeth and is not yet walking. Labs show decreased phosphorus, decreased calcium, and elevated alkaline phosphatase concentrations.

What is the diagnosis? What will x-ray show? How will you treat?
Nutritional Rickets
Radiography of his wrists documents osteopenia, with cupping and fraying of the metaphysis
200 IU Vitamin D daily or 15000mcg Vit D once and Calcium
What is vitamin D-resistant rickets?
It is (familial hypophosphatemia), which is due to a defect in the proximal tubular reabsorption of phosphates and in the conversion of 25 dihydroxy-D3 to 1,25 dihydroxy-D3. It has an X-linked dominant inheritance.
What is vitamin D dependent rickets?
These are where there is a hydroxylation problem. These kids will need 1,25 Vitamin D.
What is acrodermatitis enteropathica?
Zinc deficiency
What is menke's kinky hair syndrome?
Copper deficiency
How do you calculate caloric needs?
100 cal/kg for 1st 10 kg
50 cal/kg for 2nd 10 kg
20 cal/kg for remaining kilos
This is equivalent to 1500 cal for first 20kg and 20 cal/kg for each additional kg.
A 3 year old child whose caloric intake is consistent with RDA recommendations is in the 5th percentile for weight. What should you do?
Increase calories. The RDA recommendations are a baseline and individual needs may vary.
Why would a healthy infant who is being adequately fed still lose weight?
The infant kidney is not able to handle much of a solute load, so they could end up with fluid loss from increased osmotic load.
How much protein does a premature infant require per day?

What about a term baby in first six months of life?
3.5 grams/kg per day

2-2.5 grams/kg per day
A newborn infant undergoes GI surgery for NEC. Since the surgery he has not been gaining weight. Why?
Increased urine output due to increased renal solute load.
What comprises renal solute load?
sodium, potassium, chloride and phosphorus
When should you start cow's milk? What kind?
12 months of age. Whole milk until 2nd birthday.
Is linoleic acid an essential fatty acid?
Yes
True or False:
Commercial Infant Formula contains adequate amounts of fluoride.
False. You must get it from drinking water.
True or False:
Toddler's can get iron deficiency anemia from drinking too much milk.
True.
How much iron is in iron fortified formula?
12mg/L
A 6 month old infant who is fed iron fortified formula is brought to you because of constipation. How would you manage this problem?
A. Dilute the formula
B. Switch to low iron formula
C. Switch to whole milk
D. Add fruit juice to increase the osmotic load.
E. Add cereal to diet
D.
What are the similarities and differences between milk protein allergy (aka milk intolerance) and lactose intolerance?
1. Milk protein allergy can cause rash, vomiting and irritability.

2. Milk protein allergy is IgE mediated

3. Lactose intolerance is not IgE mediated and does not cause vomiting or rash. It may cause bloating and flatuence.
A child presents to you with scaly dermatitis with alopecia and thrombocytopenia. What is the deficiency and how do you treat it?
Fatty Acid deficiency.

Linoleic Acid
Think of a skinny fish with "scales" (platelets) falling off (going bald).
Why are preemies at risk for osteopenia?
Poor phosphorous and calcium intake. Preemies have poor absorption so need large amounts to prevent osteopenia.
A child presents to you with edema, hemolytic anemia and thrombocytosis. What is the diagnosis.
Vitamin E deficiency
Think of a "fork" that is stabbing through red blood cells and platelets come to the rescue and cause swelling.
A seven month old was weaned off breast milk one month ago now presents with facial dermatitis, less energy, diarrhea, and thinning hair. What is the diagnosis?
A. Cow milk intolerance
B. Formula intolerance
C. Zinc deficiency
D. Iron Deficiency
E. Milk protein allergy
C.
Note the thin hair.
Which formula(s) contain(s) lactose?
A. Human Milk
B. Cow based formula
C. Evaporated cow milk
D. Rice Milk
E. Soy Milk
A, B, C
Who would you give protein hydrosalate formula?
Babies with milk protein allergy and soy protein allergy.
A 32yo G1P1 woman gives birth to a 32week preemie who has bronchiolitis and RDS. The mother has been looking forward to breast feeding and is concerned that if she does not start now, then she may not have milk to give later. What do you tell her?
Applaud her for wanting to breast feed and encourage her to pump so that her baby can still get breast milk and when the baby is ready, she can start breast feeding at the breast. You may need to add fortifier or supplements to the milk.
True or False
Premature infants have lower requirements for Vitamin D.
False.
A premature infant is receiving formula that is high in polyunsaturated fatty acids and develops hemolytic anemia and decreased DTR. Why? What do you do?
The baby has Vitamin E deficiency and needs Vitamin E supplementation.
Why do premature infants require additional fat dependent vitamins?
Preemies have decreased levels of bile acids, so they have difficulty absorbing long chain triglycerides and Vit ADEK
Why do we give preemies MCT formula?
MCT does not require bile salt for absorbtion. 50% of total fat is from MCT in MCT formula.
How much MCT is in breast milk?
12%.
How long should a mom breast feed?
6 months exclusively and use it up till 12 months.
Should a mom supplement her breast milk with water?
No.
How long can you freeze breast milk? What about in the fridge? How do you thaw it?
3 months in freezer; two days in fridge; fridge, room temp or in warm water bath.
True or False:
You must sterilize all formula bottles and water that you use to mix formula.
False. Tap water is okay provided it is treated city water.
True or False: You should always use cold water to make formula to protect from lead contamination.
True.
What two amino acids are present in colostrum but not in mature milk?
Why are they important?
arachiodonic acid and docosahexaenoic acid
Neurologic development
What mineral is present in colostrum but lacking in mature milk?
Zinc
True or False: Mature milk is lacking in ergo-cholecalciferol and thus increases the risk of rickets.
False. Colostrum is lacking in ergo-cholecalciferol and thus increases the risk for rickets.
Which part of the breast milk is highest in fat?
Hind milk
If a child has milk protein allergy you should use
A) Rice Milk formula
B) Goat's Milk
C) Soy Milk formula
D) Elemental formula
E) Breast milk
D
Compare the amounts of the following for colostrum vs mature breast milk?
Protein
Fat
Lactose
Energy/Content
Minerals
Protein is higher in colostrum
Fat is higher in mature milk
Lactose higher in mature milk
Calories higher in mature milk
Minerals constant except zinc higher in colostrum
What are two risks of giving cow's milk prior to one year of age?
Hypo-cow-lcemia and anemia
What two Vitamins are breast fed babies particularly at risk of deficiency of?
Vitamins D and K
What type of Radiation does not require long term cessation of breast feeding?
Technitium 99 because it's half life is only 6 hours
Which four major medications are contraindicated in breast feeding?
Metronidazole, Diazepam and Tetracycline, Bactrim
Trichomonas, Giardia and Seizures, Acne, UTI
Which of the following are contraindications for breast feeding?
A) Candidiasis
B) TB
C) Contact Dermatitis
D) Fibrocystic Breast Disease
E) Mastitis
B
True or False: Inverted nipples can prohibit breast feeding
True
What is the difference in whey to casein ratio between cow's milk and breast milk?
Cow is 20% whey and 80% casein
Breast is 70% whey and 30% casein
Whey is way better!
What is the calcium:phosphorous ratio in cow's milk vs. breast milk
Cow is 1.5:1 and Breast is 2:1
Hypo-cow-lcemia
Of breast milk and cow's milk, which has more iron?
Which is better source of iron?
Which is better absorbed iron?
Cow
Breast
Breast
What is the caloric count of breast milk? What about standard cow milk based formula?
Both are 20kcal/oz
Cow's milk is higher in protein content. But why is it not better than breast milk?
Because whey is way better!
True or False: the earlier the delivery, the more protein needed.
False. Full term need 2-3g/kg/day
Preemie need 3-4g/kg/day
But VLBW babies can go into negative nitrogen balance if given too much protein, so they need lots of non-protein calories
Remember renal solute load esp with immature gut
How many calories does a preterm infant require per kg per day?

What about a large full term infant?
100-120 kcal/kg/day
A 16yo vegan athlete comes to you with a hemoglobin of 11. What other physical findings would you find?
a)Tachycardia
b)Nail Changes
c)nothing
d)oral lesions
e)pallor
C
True or False: Obese adolescents are protected from iron deficiency anemia
False, they are more prone to iron deficiency anemia
True or False: Iron fortified formula causes constipation.
False
A 3 month old child breast fed baby is brought in with heme positive stools but a normal exam. What do you advise mom?
A) Continue breast feeding
B) Switch to soy formula
C) Switch to hydrosylate formula
D) Switch to cow milk formula
E) Refer to GI
C or alternately you can advise mom to eliminate all milk protein from her diet.
How much is the expected daily weight gain in the first few days of life for a term baby?

For a preemie?
20-30 grams/day

15-20 grams/day
A 15yo obese teenager comes to you. What do you ask her?
How does she feel about her weight?
A 3yo child from a commune presents to you with pallor, frail reddish hair, desquamating rash and plots at the 3rd percentile for weight. On exam, he has pitting edema. What is the diagnosis?
Kwashiorkor
Another child is brought to you also plotting on the 3rd percentile, with muscle wasting, no edema, and normal hair. What is the diagnosis?
Marasmus
What is the most frequent complication of NG feeding?
Diarrhea
A 6yo is brought in for a well visit. His mom is concerned about the child's weight. She asks about her son's likelihood of being an obese adult. What is the chance that he will be an obese adult?

What if he were 12yo?
25%

75%
True or False
A tall and appropriate bone aged obese child is likely due to be obese due to exogenous factors whereas a short and fat kid with delayed bone age is likely obese due to an endocrine problem.
True
If both parents are obese what is the likelihood that the child will be obese?

What if one is obese?
2/3

1/2
Why are kids with liver disease at increased risk of Rickets?
Because they don't make bile salts and thus can't absorb Vitamins A, D, E, K
You see a 5yo with 3 day history of vomiting and diarrhea in the ED. His mouth is pasty, he has good pulses and a HR of 156. What do you do?
A) Give IV fluids
B) Discharge with BRAT diet
C) Admit for Bowel Rest
D) Discharge with oral hydration therapy and discharge with regular diet
E) Check a serum bili
F) Dilute the formula, so child can tolerate it
D
True or False:
Home made baby foods can prevent food allergies
False
What is the optimal whey to casein ratio for preemie formula?
60/40
How many calories per oz is in preemie formula?
24 cal/oz
True or False:
Preemie formula contains higher amounts of calcium and phosphorous than regular formula
True