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82 Cards in this Set
- Front
- Back
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deficiency of Vitamin ___ is the most common cause of preventable blindness in children
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A
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where is vitamin A found?
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green leafy vegetables, carrots, sweet potatoes and liver
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what is the function of vitamin A in the body?
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growth and health of epithelial cells in eye, respiratory, urinary and digestive tract
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__-% of food borne diseases are in green leafy vegetables
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50
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what is the clinical manifestation of vitamin A deficiency?
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-Nyctalopia (night blindness)
-corneal xerosis (dry eye) -keratomalacia (ulcerations) -blindness once ulcerations occur -failure to thrive and depressed immune funciton -increase risk of diarrhea disease |
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where is thiamine found?
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-yeast, legumes, pork, rice, cereals, milk and veggies
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ToF: cooking destroys thiamine
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true
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what occurs if you are deficient of thiamine?
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you will develop wernicke-korsakoff syndrome OR in infancy cardiac failure
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what is beriberi?
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thiamine deficiency leading to cardiac failure, loud piercing cry and vomiting
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what are the symptoms of Wernicke-Korsakoff syndrome?
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-irritability
-peripheral neuritis -decrease tendon reflexes -loss of vibration sense -aseptic meningitis -ataxia |
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how does vitamin A deficiency present?
1. diarrhea 2. corneal xerosis 3. refractory seizures 4. macrocytic anemia |
2
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What are the food that contain riboflavin (B2)?
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fish, eggs, meats, green vegetables, yeast and milk
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what are the symptoms of riboflavin deficiency?
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-cheilosis
-glossitis (smooth tongue) -keratitis -photophobia -seborrheic dermatitis -sore throat, hyperermia of mucosal surfaces -normocytic anemia |
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where can one get niacin (B3)?
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milk and eggs in large quantities
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What are the clinical manifestations of Niacin deficiency?
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3 D's
-diarrhea -dementia -dermatitis (sunburn on the photosensitive areas of the skin) from malnutrition and tryptophan deficient corn diets |
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What is pyridoxine and where is it found?
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B6:
-yeast, rice polishing, cereals main sources |
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what are the conditions that increase the risk for B6 deficiency?
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exclusively breastfed infants if the mother is deficient
-INH -diarrhea -malnutrition |
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what vitamin is only found in red meat?
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B12
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___ in the terminal ileum absorb B12 and allow it to be recycled
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enterocytes
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B12 is excreted in __ and reabsorbed in the __ ___
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bile; terminal ileum
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there are large stores of B12 in the ___
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liver
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what are the clinical manifestations of B12 deficiency?
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-neurologic: developmental delay, paresthesia, impaired vibratory, propriceptive sense, hypotonia, seizures, ataxia, memory loss, depression, weakness, poor school performance
-hematologic: macrocytic anemia, thrombocytopenia, leukopenia, pancytopenia |
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What is a major risk factor for B12 deficiency?
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short bowel syndrome and veganism
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what are the tests that will help diagnose B12 deficiency?
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-Methlmalonic acid (MMA) elevated** specific for B12
-Homcysteine level -B12 level |
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Scurvy or ___ disease occurs after __ to ___ months of vitamin C deficiency.
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barlow; 1-3
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How are newborns protected agains scurvy?
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human milk and formula contains vitamin C
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what are the signs of vitamin C deficiency?
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bleeding, osteopenia, and gingival disease
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How does Vitamin C deficiency present?
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pseudoparalysis
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ToF: all newborns need to be started on vitamin D within the first year of life
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True: but even more specific, the first few days!!!
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what are the natural sources to get vitamin D?
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cod liver oil, liver, macherel and sardines, the sun and fortified foods
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D3 is ___ time (more/less) potent than D2
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three; more
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What is the clinical presentation of vitamin D deficiency in infancy?
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-FTT
-seizures and tetany due to calcium deficiency -widened cranial sutures -frontal bossing -hypotonia |
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what is the presentation of an older child and children with vitamin D deficiency?
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-bony change
-delayed tooth erruption -bowed legs (ricketts) -kyphosis -pelvic abnormalities -pot belly |
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what are the conditions that are linked to vitamin D deficiency?
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-lymphoma
-breast cancer -autoimmue disease -osteoarthritis -type I DM -CVD -schizophrenia -depression |
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What disorder is associated with Harrison's groove, costal rosary and bowed legs
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ricketts
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where is alkaline phosphatase found in the body? when should levels be high?
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bone and liver. Should be high when you are growing
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Vitamin E deficiency results from malabsorption, __ __ __ liver disease
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short bowel choestasis
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___ ataxia is caused from vitamin E deficiency.
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fredereich
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what happens in the eye with vitamin E deficiency?
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wiggly vessels in the sclera
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what lab value is a sign of vitamin E deficiency
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serum alpha tocopherol level less than 5 mg
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what is the new guidelines for prevention and treatment of obesity in 5-11yo?
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focused energy-based CHILD-1 diet/physical activity education
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what is the followup time frame for a child with increasing BMI?
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3 months
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what is the plan for a child with BMI > 95th % and no comorbidities?
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-office based weight loss plan
-family-centered program for behavior modification -energy-balanced diet -counseling by RD -prescription for increase moderate to vigorous physical activity -decrease sedentary time for 6 months -if improvement, continue plan -if no improvement then refer to comprehensive multipdisciplinary, life-style weight loss program |
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ToF: the greatest weight loss is achieved when parents are the focus of the intervention.
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true
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what is the treatment for a child 12-21 with >95th BMI with comobrbidities or BMI > 35 and no improvement after initial weight loss plan?
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consider initiation of orlistat under care of experienced clinician for 6-12 months
-if that does not work consider bariatric surgery (last resort) |
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ToF: for adolescents with obesity, the patient weight change waas achieved when the parent was the primary focus of the intervention.
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false: the child
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what are the overall nutritional recommendations for children?
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--800 IU per day of vitamin D after first year of life
--fish oil may not be safe if they are on anticoagulants or if they are not safely tested for mercury, heavy metals, dioxins, and PCB -make sure Ca intake is normal -promote diets rich in antioxidants -avoid fructose corn syrup and processed foods |
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ToF: eating disorders followed a bell curve for age group most effected
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false: bimodal peak of one during adolescents years --14.5 and 18 years
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what is the diagnostic criteria for Anorexia nervosa?
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-refusal or inability to maintain body weight over a minimum normal weight
-intense fear of gaining weight or becoming fat despite being underweight -disturbance in body shape -in post-menorrheal femals, absence of 3 consecutive menstrual cycle (amenorrhea) -often exists comorbid with depression and ritualistic behavior |
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describe the restricting type AN.
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-during the current period of AN, the person has not regularly engaged in binge-eating or purging behavior. there is no:
--self-induced vomiting --misuse of laxatives, diuretics or enemas |
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what is the binge-eating/purging type of anorexia nervosa?
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-during the current period the person regularly engage in binge-eating and purging.
--self induce vomiting --misuse laxatives, enemas and diuretics |
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in BN, vinge eating and recurrent inappropriate behavior can occur at least __ a week for __ __
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twice; 3 months
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what are the diagnostic criteria for Eating disorder NOS?
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-all criteria for AN but has regular meneses
-all criteria for AN, but weight is in normal range -all criteria for BN but binges less than twice a week or less than 3 times a month, a patient with normal wieght who regularly engages in appropriate compensatory behavior after eating a small amount of food -a patient who chew but spits out food withut swallowing -regular binger who does not engage in the appropriate compensatory behvariors |
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what is FAT?
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female athlete triad:
-disordered eating -menstrual dysfunction -osteoporosis |
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what are the characteristics of weight issues in female athletes?
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-FAT
-compulsive exercising -binge eating and purging -using lax, diet pills, diruetics -food restriction: energy depletion |
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what are the sports that often have FAT?
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distance runners
gymnastics swimming |
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what are the causes of eating disorders?
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-biological
-psych -family -societal -associated disease condition -personal perspective of body image |
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ToF: girls with advance pubertal development at early age are less at risk for developing AN or BN?
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false: more likely
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Nurses have been known to have which eating disorder
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over eaters
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what is the screening tool for eating disorders?
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SCOFF
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what is the SCOFF questionaire?
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for eating disorders
1. do you make yourself SICK b/c you feel uncomfortably full? 2. do you worry that you have lost CONTROL over how much you eat? 3. have you recently lost >1 stone (6.3 kg or 14 lbs) in a 3 mo period? 4. do you believe yourself to be FAT when others say you are thing? 5. would you say that FOOD dominates your life? |
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what is considered moderate malnutrition for AN/BN?
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20% below the IBW
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what is severe malnutrition?
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25% below the IBW
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what are the significant findings when conducting a test for orthostatic hypotension?
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-increase of 20 beats per minute while standing
-decrease of 20 mm Hg in systolic BP -decrease of 10 mm Hg in diastolic BP |
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what are the notable physical exam findings for eating disorders?
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-scaphoid abdomen
-muscle wasting -acrocyanosis -decreased subcutaneous fat -lanugo hair, -ecchymosis -diminshed reflexes, -and dry skin |
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what is the name of the callous on the knuckles from self-induced vomiting?
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Russel sign
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ToF: patients with eating disorders tend to have carotenemia
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true: particularly on the palms and soles
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what cardiac condition can result from AN?
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mitral valve prolapse, bradycardia, pericardial effusion and ECG abnormalities
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which eating disorder is associated with emetine cadiomyopathy
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BN
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ToF: acute pancreatitis is a complication of AN
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false: BN
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what is the name of a tear at the junciton of the stomach and esophagus? what group often gets this?
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Mallory weiss tear; BN
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Hypochloremic metabolic alkalosis is a result of ___
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vomiting from BN
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what are the physical complications of binge eating?
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-gastric/duod ulcer
-rupture -parotid swelling (associated with high carb) -pancreatitis -dental caries |
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what are the complications of vomiting?
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-hypokalemia
-metabolic alkalosis -dehydration -hypomagnesia -esophagitis aspiration pneumonia |
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ToF: orthostatic Hypotension in a comp of BN
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false: AN
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review the criteria for hospital admission for AN
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review hospital admission criteria
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what are the complications of laxatives? and diuretics?
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-metabolic acidosis
-steatorrhea -constipation -rectal bleeding -hypokalemia -pancreatitis |
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what is the psychopharmacologic therapy for BN?
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-recent use of SSRI in bulemia
-Prozac (fluoxetine) and 60mg a day most effective |
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What is the likely dx if the patient is telling you that their symptoms are not matching one system.
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somatization
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what should primary care providers-families and schools encourage for children eating disorders?
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-self assertiveness
-critical thinking -self-esteem |
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what should primary care providers-schools and parents avoid doing with kids with eating disorders?
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-avoid categorizing foods
-avoid ideas of perfectionism and dieting |
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what is the overall prognosis for eating disorders?
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-severe AN protracted course with recovery estimates 10-15 year slater from 76 to 24%
-50% do well in long term -20% do poorly -30%show varying degrees of improvement |
