Term
Copper deficiency is associated with
1: leukocytosis
2: macrocytic anemia
3: microcytic hypochromic anemia
4: erythrocytosis |
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Definition
microcytic hypochromic anemia
Deficiences of iron or copper result in microcytic hypocrhomic anemia (small red blood cells that are pale in color due to decreased heme pigment). |
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Term
A patient receiving PN has high ileostomy output. Which of the following changes to the PN prescription is most appropriate to recommend?
1: increased sodium and increased fluid volume
2: decreased water and decreased sodium
3: increased sodium and decreased protein
4: decreased sodium and increased fluid volume |
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Definition
| Patients with high ileostomy or small bowel fistula output are at high risk for water and electrolyte losses. The sodium content of ileostomy output can be as high as 120 mEq/liter. Hyponatremia can result when fluid replacement does not contain adequate sodium to correct for ileostomy losses. |
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Term
Which of the following if a clinical characteristic of acute disease or injury related severe malnutrition?
1: moderate depletion of body fat
2: mild fluid accumulation
3: mild depletion of muscle mass
4: 10% weight loss in 6 months |
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Definition
Clinical characteristics to diagnose malnutrition of acute or injury-related disease are weight loss of >2% of body fat, >5% in 1 month, >7.5% in 3 months, energy intake of <50% for >5 days, moderate depletion of body fat, moderate depletion of muscle mass, and moderate to severe fluid accumulation.
10% in 6 months counts for chronic |
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Term
Which of the following condition are most likely to result in malnutrition of mild to moderate inflammatory response?
1: anorexia nervosa
2: cancer
3; closed head injury
4: sepsis |
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Definition
| The presence of inflammation of mild to moderate degree can result in chronic diseases-related conditions such as organ failure, cancer, rheumatoid arthritis, and sarcopenic obesity. Marked inflammatory responses can result in acute disease or injury-related malnutrition in conditions such as major infection, burns, trauma, and closed head injury |
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Term
Which of the following is common in both acute illness or injury-related and social or environmental related malnutrition?
1: ketosis
2: hypoglycemia
3: lipolysis
4: hypermetabolism |
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Definition
| Catabolism of endogenous substrate including fat stored in adipose tissue (lipolysis) is common in both forms of malnutrition. Hypoglycemia and ketosis are characteristic of starvation. Hypermetabolism and hyperglycemia are characteristic of stress-related malnutrition. |
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Term
The subjective global assessment uses which of the following to evaluate the nutritional status of patients?
1: dietary intake, delayed hypersensitivity skin testing, and weight history
2: weight history, dietary intake, and gastrointestinal symptoms
3: laboratory indices, weight history, and gastrointestinal symptoms
4: arm anthropometry, dietary intake, and laboratory indices |
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Definition
| The SGA has been applied successfully as a method of assessing nutritional status in a variety of patient populations. It integrates five historical (weight history, dietary intake, gastrointestinal symptoms, functional status, metabolic demand) and four physical examination parameters (subcutaneous fat, muscle wasting, edema, ascites) to define nutritional status. |
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Term
Which of the following has been reported to be a significant independent predictor of morbidity and mortality in critically ill patients?
1: albumin
2: prealbumin
3: transferrin
4: retinol-binding protein |
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Definition
| Albumin is a significant independent predictor of morbidity and mortality. ICU and hospital length of stay, ventilator days, risk of infection and mortality were significantly greater for patients with a serum albumin <2.6 g/dL |
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Term
A previously well-nourished patient with persistent fever is admitted to the hospital. His laboratory tests reveal: albumin 2.1 g/dL; C-reactive protein 30 mg/L; serum calcium of 7.2 mg/dL. Which of the following is the most likely etiology of hypoalbuminemia?
1: caloric deficiency
2: protein deficiency
3: hypocalcemia
4: inflammatory response |
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Definition
| Albumin may decrease during inflammation and hypervolemia. Even though it is a good predictive indicator of clinical outcome, it does not always reflect nutritional status. Elevated C-reactive protein relfects an inflammatory status, which may be the reason for hypoalbuminemia. Positive acute phase protein concentrations such as C-reactive protein increase during inflammation, whereas negative acute phase protein concentrations such as albumin and pre-albumin decrease during inflammation. Although there is a casual relationship between hypoalbuminemia and hypocalcemia, a low serum calcium does not cause a low albumin. |
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Term
Which of the following compromises the reliability of urinary urea nitrogen to calculate nitrogen balance?
1: protein intake <0.5 g/kg/day
2: creatinine clearance <50 mL/min
3: diuresis >2.5 L
4: fecal nitrogenn >1g |
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Definition
| Urine urea nitrogen is used primarily to monitor protein intake during nutrition support. Urine is usually collected for a 24 hour period in order to quantify the amount of urinary urea nitrogen. Compromised renal function, as indicated by a creatinine clearance <50 mL/min, low urine output, and muscle atrophy can alter urinary urea nitrogen, resulting in unreliable results. |
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Term
Which of the following has been shown to reduce plasma homocysteine concentrations?
1: folic acid
2: vitamin E
3: l-carnitine
4: ascrobic acid |
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Definition
| Hyperhomocysteinemia has been linked to an increased risk for coronary artherosclerosis. Studies have shown that folic acid, vitamin B6, and vitamin B12 supplementation can reduce plasma homocysteine concentrations. It is not known whether hyperhomocysteinemia is a causative factor of artherosclerosis or simply a marker of vascular disease. |
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Term
Which of the following if the most appropriate fluid requirement for a healthy 78-year old adult?
1: 20 mL/kg
2: 25 mL/kg
3: 35 mL/kg
4: 45 mL/kg |
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Definition
| The fluid requirements for healthy adults are 35 mL/kg for adults age 18-55, 30 mL/kg for adults age 55-75, 25 mL/kg for adults older than 75 years, and less than 25 mL/kg when fluid restriction is indicated. |
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Term
Which of the following enzymes initiates the digestive process of carbohydrates in the mouth?
1: lipase
2: lactase
3: maltase
4: amylase |
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Definition
| The salivary gland releases an enzyme called alpha amylase that initiates hydrolysis of carbs when food enters the mouth. The degree of hydrolysis depends on the time that food is chewed and the nature of the food that enters the stomach. Lipase is an enzyme released from the pancreas that is important in the digestion of fat. Both lactase and maltase are located in the brush border cells of the small intestine and are important in intraluminal carbohydrate digestion. |
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Term
Iron is primarily absorbed in the
1: stomach
2: colon
3: ileum
4: jejunum |
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Definition
| Iron is absorbed primarily in the duodenum and jejunum in the ferrous state rather than the ferric state. The ferric form of iron is insoluble in aqueuos solutions and, therefore, not absorbed. Gastric acid is very important in maintaining dietary iron in the ferrous state. |
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Term
Which of the following amino acids is most crucial in small intestine structure and function?
1: alanine
2: leucine
3: aspartate
4: glutamine |
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Definition
| While all amino acids are important in metabolism, glutamine is a key fuel for the small intestine. Glutamine is essential for small intestinal structure and function. It could be useful to supplement glutamine to patients who are suffering trauma or receiving parenteral nutrition. |
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Term
In patients with phenylkeonuria (PKU), tyrosine becomes an essential amino acid due to
1: an increase in the tyrosine hydroxylase enzyme
2: a deficiency in the phenylalanine hydroxylase enzyme
3: an increase in the phenylalanine hydroxylase enzyme
4: a decrease in the tyrosine hydroxylase enzyme |
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Definition
| PKU is an inborn error of phenylalanine metabolism cause by a deficiency of the hepatic enzyme phenylalanine hydroxylase (PAH). PAH catalyzes the hydroxylation of phenylalanine to tyrosine. In the absence of PAH, phenylalanine levels become extremely high and tyrosine becomes deficient. Treatment with a phenylalanine-free diet and tyrosine supplementation is used for chronic management. |
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Term
| conditionally indispensable amino acids |
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Definition
amino acids that are synthesized from other amino acids under normal conditions but require a dietary source in order to meet increased needs caused by metabolic stress
ex. arginine, cysteine, glutamine, proline, tyrosine |
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Term
| Which IV fluid most closely resembles jejunal and illeal electrolyte content? |
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Definition
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Term
| Lactic acidosis can be a result of which vitamin deficiency? |
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Definition
thiamine
necessary for metabolism of glucose (conversion of pyruvate of to acetlyl CoA)
if thiamine is absent, pyruvate is converted to lactic acid |
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Term
| risk of metastatic calcification in soft tissues begins to increase when the product of serum calcium and phosphorus exceeds... |
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Definition
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Term
| hepatic encephalopathy is most likely to be improved with which trace element? |
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Definition
zinc
- supplementation associated with improvement in amino acid metabolism and encephalopathy |
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Term
| Chelosis (cracking of the corners of the mouth) is a physical symptom associated with... |
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Definition
| riboflavin, niacin, iron, and pyroxidine |
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Term
Patient with end stage liver disease, on TPN, ascities, Na level of 124.
What changes should we make? |
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Definition
fluid and sodium restriction
change protein needs (0.8-1.2 g/kg for maintenance, 1.3-2 g/kg for repletion) |
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Term
| What is the approximate normal length of the small intestine in adults? |
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Definition
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Term
| What is the primary fuel of colonocytes? |
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Definition
| short chain fatty acids (SCFAs) |
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Term
| Which areas of the GI tract have the LEAST impact on nutrient absorption and intestinal adaption following significant intestinal resection? |
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Definition
| proximal bowel (duodenum and proximal jejunum) |
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Term
| Valporic acid (seizure medication) can induce a deficiency in which nutrient? |
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Definition
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Term
| Methotrexate acts by interfering with the normal intracellular metabolism of... |
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Definition
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