exam 1

A deficiency in the number or size of red blood cells or in the amount of hemoglobin

Anemia

What hormone should be given during anaphylaxis and why?

Epinephrine -opens airways and increases BP

True or False: An allergic reaction will occur during the first exposure do a food.

FALSE 1st exposure -> sensitization -> produce IgE for the food but do not show symptoms yet

True or False: Hypertension results in allergic reactions.

FALSE HYPOtension results due to histamine (a vasodilator)

True or False: COPD patients should be on a low-carb diet since carbohydrate metabolism produces more CO2.

FALSE MODERATE carb, moderate fat; be careful to not overfeed TOTAL calories

True or False: CF patients with steatorrhea should go on a low fat diet.

FALSE MODERATE fat diet!!! (35-40% total kcal) --> treat malabsorption with pancreatic enzymes

True or False: Infants with galactosemia can have breastmilk.

FALSE NO breastmilk allowed; need to use a soy-based formula

True or False: Pancreatic insufficiency is considered a cause of food allergies.

FALSE a cause of *food intolerances*

True or False: Antioxidants, probiotics, omega-3s, and vitamin D have been proven to prevent food allergies.

FALSE currently being researched

True or False: Skin prick testing is highly accurate for diagnosing food allergies.

FALSE has a lot of false positives; best for ruling out what you're NOT allergic to

True or False: High carbohydrate foods most commonly cause food reactions.

FALSE high protein foods are common allergens (milk, eggs, peanuts, tree nuts, soy, wheat, fish, shellfish)

True or False: Nutrition is usually not a large issues in sickle cell anemia.

FALSE malnutrition is COMMON (decreased food intake due to pain and increased REE)

True or False: Everyone with a food intolerance needs to strictly avoid the food that causes symptoms.

FALSE may be able to handle certain amounts

True or False: Rapid weight loss is beneficially for patients with gout.

FALSE rapid weight loss increases cell turnover and ketones which can precipitate a gout attack

True or False: The only source of food infants should receive is a phenyl-free formula.

FALSE should intake a specific amount of breastmilk

True or False: Iron deficiency symptoms begin at the first stage.

FALSE symptoms do not appear until stage 4

At hat stage does iron-deficiency anemia occur?

FINAL STAGE (stage 4) -decreased hemoglobin and hemocrit

Research says that ____ may be about to replace cornstarch.

MCT oil

An increased MCV and/ or MCH indicates...

Macrocytic anemia

A decreased MCV and/ or MCH indicates...

Microcytic anemia

What are the causes of normocytic anemia?

NON-nutritional causes -hemorrhage or blood loss -renal disease -aplastic anemia (bone marrow RBC prod decreases) -pregnancy -sickle-cell anemia

What is non-immune and characterized by loss of articular cartilage?

Osteoarthritis (OA)

What blood lab reflects long-term folate status?

RBC folate

What stress factor and protein should be used for aspiration pneumonia?

SF for infection: 1.0-1.4 protein: 1.2-1.5 g/kg

Chronic, systemic, sclerosis of skin due to the build-up and deposition of collagen/ fibrous tissue which hardens.

Scleroderma

What should be excluded on a PKU diet?

all protein foods: meats, fish, poultry, dairy, eggs, legumes, nuts, and seeds

What is the mechanism for IgE-mediated food allergies?

allergen + allergen-specific IgE + mast cells --> release histamine, interleukins, prostaglandins

Atropic eczema=

an IgE-mediated skin reaction to a food allergen commonly seen on the back of knees and inside of elbows

What blood levels should phenylalanine be maintained to?

between 60 and 360 umol/L (1-6 mg/dL)

Azathioprine (Imuran) is a drug used in RA. What are its DNI?

causes N/V and loss of appetite

What are complementary therapies for osteoarthritis?

combined chondroitin sulfate (1500 mg) and glucoamine (1200 mg) may reduce moderate to severe pain

What are the issues with Comfrey therapy?

contains PA (pyrrolizidine alkaloids) which *damage the liver*

What cardiac condition is a complication of COPD?

cor pulmonale= right-sided heart failure

What does the consensus formula take into account?

lung function and decrease of fat malabsorption

What is the major goal for glycogen storage disease?

maintain normal blood glucose levels (70-120 mg/dL)

How does CF affect carb metabolism?

may have CF-related diabetes due to pancreatic insufficiency

What is intrinsic factor needed for?

needed to absorb vitamin B12

What is a major consequence of vitamin B12 deficiency?

nerve damage and impaired cognitive function ~neurological symptoms (ex. paresthesia (tingling), poor muscular coordination, poor memory, etc.)

What are tests for immunologically testing (2)?

skin prick and CAP-FEIA blood test

What are the stages of iron deficiency?

stage 1: moderate depletion of iron stores (low serum *ferritin*) stage 2: severe depletion of iron stores stage 3: decreased serum iron stage 4: iron deficiency anemia

What are the issues with Alfalfa therapy?

stimulates the immune-system which is not good for patients with autoimmune disorders

What is considerred the "obstruction" in chronic bronchitis?

the inflammed, narrowed bronchi and excessive mucus

Why would you need to reduce dietary iron intake in sickle cell anemia?

there is an increase of iron in the blood due to high breakdown of hemoglobin

What condition leads to a higher risk of reaction to sulfites?

those with *asthma*

Why should patients with aspiration pneumonia be NPO intitially?

to find out if the aspiration is chronic or a one time occurance

What vitamin is at risk for deficiency in SLE?

vitamin D -may not get enough sun due to sun sensitivity

What antioxidant is needed for RA?

vitamin E

How much time does it take for a reaction to food to usually occur?

within 2 hours of exposure

What is tartazine considered on food labels?

yellow dye #5

What supplement may be used in the treatment of sickle cell anemia?

zinc supplementation -increase the O2 affinity of RBS -needed for growth (especially for kids)

What diet and extra nutrients are recommended for Osteoarthritis?

-"anti-inflammatory diet" -DRI for calcium and vitamin D

What are nutritional factors that have a strong association with gout?

-*obesity* and excessive eating -drinking alcohol -ketosis (low carb or fasting) -exercise may cause an attack

What is the MNT for folate deficiency?

-1 mg of folic acid -at least 1 fresh, uncooked fruit or veg./day -consume fortified grains, fish, and legumes

What are the risk factors for Osteoarthritis (5)?

-Obesity -Aging -female gender -genetic factors -repetitive-use injury

What are examples of systemic, autoimmune rheumatic diseases?

-Rheumatoid Arthritis -Fibromyalgia -Scleroderma -Lupus

What are the DNI of corticosteroids?

-decreased Calcium absorption, increased Calcium resorption and excretion -Sodium retention -Increased blood sugar (hyperglycemia) -hyperlipidemia -hypertension (HTN) -increased appetite, weight gain -lean body mass loss/muscle wasting

What are non-heme sources of iron?

-fortified cereals, breads, nutrition bars -dried peas and beans -tofu -spinach -nuts

What is the MNT for Sickle Cell Anemia?

-high kcal/ high protein diet -drink plenty of fluids -increase dietary folate sources -AVOID iron supplementation -may need to reduce dietary iron intake

What are the causes of vitamin B12 deficiency?

-inadequate absorption due to *lack of intrinsic factor*, ileal disease, pancreatic insufficiency -inadequate intake (vegan, poverty) -increased excretion due to liver disease

What is the MNT for Gout?

-increase fluid consumption to 8-16 cups/day -abstain from alcohol -limit animal foods to 4-6 oz per day during an attack -moderate protein intake from low fat sources -avoid consumption of fructose (HF corn syrup) -promote weight loss

How does the body compensate for depleted iron stores during stage 1? (2)

-increases rate of GI absorption of iron -increases serum transferrin

What is the MNT for pernicious anemia (3)?

-intra-muscular injection of 1000 micrograms of vitamin B12 -increase dietary sources of B12 (animal products and fortified cereals) -increase protein to 1.5 g/kg

What nutrients can lead to anemias if deficient?

-iron -vitamin B12 -folate -vitamin B6 (pyridoxine) -protein -copper

What are the causes of microcytic anemia?

-iron deficiency -sideroblastic anemia -thalassemia -copper deficiency

What is the MNT for glycogen storage disease?

-limit fructose, sucrose, galactose, and lactose -given RAW, UNcooked cornstarch in between meals and at night to maintain BG -MVI with mineral -Calcium supp -Iron supp

What minerals/electrolytes are important for respiratory muscle function?

-phosporus -magnesium -calcium -K+

What are the clinical manifestations of glycogen storage disease?

-severe *hypoglycemia* -hepatomegaly -decreased growth -lactic acidemia -hypertriglyceridemia and hypercholesterolemia -hyperuricemia

What is the MNT for Xerostomia?

-soft moist foods -add sauces -LIMIT caffeine -drink water throughout the day -avoid acidic beverages (soda, citrus juice) -use sugar-free candy or gum -lemon drops

What biochemical tests can be used to rule out non-allergic causes of symptoms (3)?

-stool samples -lactose intolerance test -celiac disease testing

What drugs can lead to a folate-deficiency (3)?

-sulfasalazine -anticonvulsants -methotrexate

What inhibits iron absorption (5)?

-tannins (tea and coffee) -excessive fiber -phytates (whole grains, bran, soy) -calcium (dairy products) -egg yolks

What are the causes of macrocytic anemia?

-vitamin B12 deficiency -folate deficiency -drug-induced disorders of DNA synthesis (chemotherapy)

What factors increase iron absorption?

-vitamin C (included sources at each meal) -non-heme iron taken with heme-iron

What stress factor should be used when calculating energy needs in sickle cell anemia?

1.2-1.5

What are the protein requirements for RA?

1.5-2.0 g/kg proetin

How long does it take for folate body stores to deplete on a folate-deficient diet?

2-4 months

How much iron supplementation is taken by adults with iron deficiency anemia?

50- 200 mg of iron in ferrous form

Special Phe-free formula will provide _____% of protein needs and _____% of energy needs for infants and toddlers.

90% of protein, 80% of energy

Where are tyramines and histamines naturally found?

AGED cheese and meats, fermented products, red wine, canned fish

What are examples of bronchodilators and their DNI?

Albuteral: limit caffeine intake (both stimulators); causes elevated glucose and decreases serum K+ Theophylline: avoid drastic changes in caffeine intake; avoid a high protein/low carb diet (increases the drugs metabolism) Guaifenesin (expectorant): N/V/D

Why would you need to worry about sugar-free products for someone with PKU?

Aspartame contains phenylalanine

Which is an immune-system response to food? a. food allergy b. food intolerances c. food sensitivity

Food allergy

What are the manifestations of scleroderma?

GERD, N/V/C/D, *dysphagia*, malabsorption, SIBO, loss of peristalsis, weight loss, *malnutrition*

What is a complementary therapy for RA?

Gamma-linolenic acid (GLA) -omega 6 that acts like an omega-3 (anti-inflammatory) -*increases the risk of bleeding* -found in primrose oil and borage seed oil

Arthritis cause by a disorder of *purine* metabolism and the accumulation of uric acid in and around the joints

Gout

What can increased PaCO2 lead to?

Hypercapnia and Respiratory Acidosis (blood is too acidic)

When would you use EN in scleroderma?

If the patient is having severe dysphagia

What is the most common type of allergic reaction?

IgE-mediated

True or False: A deficiency in vitamin B12 can lead to a folate deficiency?

TRUE

True or False: Drugs are the main treatment for gout since most uric acid is produced endogenously.

TRUE

True or False: If while treating iron deficiency, you should avoid drinking large amounts of tea or coffee with meals.

TRUE

True or False: Rheumatoid arthritis may result in TMJ.

TRUE

True or False: a vitamin B12 deficiency takes a long time to develop (over a year).

TRUE

True or False: Infants under 6 months old should not have raw cornstarch.

TRUE -have a hard time digesting

True or False: PKU formulas contain high osmolarity which can cause diarrhea.

TRUE -provide adequate fluid

What vitamin do smokers have an increased need for?

Vitamin C (16-32 mg about the DRI)

Maple Syrup Disease

a metabolic disorder where you cannot breakdown BCAAs (isoleucine, leucine, valine) which buildup and cause *ketoacidosis*

Increased homocysteine may indicate...

a vitamin B12 deficiency

What blood lab indicates early signs of vitamin B12 deficiency?

low holo-TCII value

koilonychia

damaged, concaved in fingernails seen in iron-deficiency anemia

When should you do a sodium and fluid restriction in COPD patients?

edema or cor pulmonale

Why could supplementation of folic acid led to adverse consequences if not deficient?

folic acid supplementation can mask vitamin B12 deficiency

Classic Galcatosemia results in the accumulation of ______ which is toxic to the __________ (4)?

galactose-1-phosphate which is toxic to the CNS, liver, kidneys, and eyes

Atopy=

genetic predisposition to developing allergies

What is released during the inflammatory response?

histamine, prostaglandins, plasma proteases, cytokines

When would you want to restrict sodium and fluid in systematic lupus erythematosus?

if the patient has renal disease

Sjogren's Syndrome

immune-disorder that attacks the moisture producing glands (ex. salivary glands) that leads to: -xerostomia (dry mouth) -dental decay -dysgeusia (altered taste) -dysphagia

Where are purines mainly found?

in high protein foods -meats, seafood, yeast extracts, beer/alcohol

Where is the only place vitamin B12 is absorbed?

in the ileum

How often should infants and children with glycogen storage disease be feed?

infants: feed every 2-3 hours children: feed every 3-4 hours (2/3 of kcal during the day, 1/3 at night)

Where does inflammation start in Rheumatoid Arthritis?

inflammation starts in the synovial membrane and progresses to joint cartilage

Methotrexate is a drugs used in RA. What are its DNI?

inhibits conversion of folate to active form -> folate deficiency *need to take 1 mg folic acid on days you do not take the drug*

Why is shark cartilage an issue in?

its a cheap source of chondroitin sulfate that can causes N/V/C, abdominal cramps, low BP, elevated serum glucose and calcium, and general weakness

What is the MNT for galactosemia?

lifelong avoidance of galactose and lactose -avoid dairy products -avoid foods with >20mg galactose/ 100g -Calcium supplement

What are heme sources of iron?

liver, beef, pork, chicken, turkey, clam, oysters (animal sources)