Nutrition Deficiencies and Recommendations Quiz

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Questions and Answers

Which of the following clinical manifestations is MOST characteristic of riboflavin deficiency?

Scrotal or vulvar dermatosis

Photophobia, blurred vision, itching of the eyes, lacrimation & corneal vascularization

Seborrheic dermatitis of the face

Angular stomatitis (correct)

What is a possible reason for impaired absorption of Riboflavin?

Amino acid imbalance

Low dietary intake of tryptophan

Achlorhydria, diarrhea and vomiting (correct)

Excessive consumption of corn products

What is the recommended daily allowance (RDA) of thiamine for nursing mothers?

1-1.3 mg

0.6-1.2 mg

1.5 mg (correct)

0.4 mg

Which of the following is NOT a clinical manifestation of thiamine deficiency (Beriberi)?

Photophobia (A) Signup and view all the answers

A patient presents with symmetrical erythema, scaling, and pigmentation on the back of their hands, wrists, and forearms. Which of the following vitamin deficiencies is MOST LIKELY responsible?

Niacin (B) Signup and view all the answers

What is the recommended daily allowance (RDA) of Riboflavin for infants and children under 10 years old?

1.4-2mg (A) Signup and view all the answers

What is the MOST common treatment for Riboflavin deficiency?

Oral administration of Riboflavin with increased B complex (C) Signup and view all the answers

Which of the following is a classic triad of symptoms associated with Niacin deficiency?

Dermatitis, Diarrhea, Dementia (B) Signup and view all the answers

What are the primary consequences of carbohydrate imbalances in nutrition?

Hypoglycemia and obesity (D) Signup and view all the answers

Which forms of malnutrition are classified under specific deficiency?

Kwashiorkor and iron deficiency (C) Signup and view all the answers

Which micronutrient deficiency is primarily associated with the disease scurvy?

Vitamin C (D) Signup and view all the answers

What is the primary etiology of marasmus in infants during the first year of life?

Insufficient breastmilk and poor hygiene (C) Signup and view all the answers

Which of the following conditions is NOT a consequence of malnutrition?

Diabetes (B) Signup and view all the answers

Which laboratory finding is typically NOT associated with marasmus?

High glucose tolerance (B) Signup and view all the answers

What form of malnutrition is characterized by an excess of one or more essential nutrients?

Overnutrition (B) Signup and view all the answers

Which mineral deficiency is primarily linked to anemia?

Iron (A) Signup and view all the answers

Which characteristic is not commonly associated with kwashiorkor?

Dehydration (C) Signup and view all the answers

What is considered a critical time period for treatment in cases of severe PEM?

First 48 hours (A) Signup and view all the answers

In the treatment of severe PEM, what initial treatment is prioritized upon admission?

Vitamin deficiencies (C) Signup and view all the answers

Which form of deficiency is observed in kwashiorkor patients as a laboratory finding?

Iron and folic acid deficiencies (B) Signup and view all the answers

At what percentiles of BMI does the CDC classify individuals as 'at risk' and 'more severe'?

85th and 95th (C) Signup and view all the answers

In cases of kwashiorkor, which clinical manifestation is least likely to be expected?

Excessive physical activity (C) Signup and view all the answers

When high energy feeds are initiated in the rehabilitation phase of PEM, what is the typical caloric range suggested?

150-200 kcal/kg/day (C) Signup and view all the answers

What is one of the serious potential causes of mortality in cases of severe PEM treatment failure?

Cardiac shock (A) Signup and view all the answers

Which of the following is NOT a symptom associated with thiamine deficiency (Beriberi)?

Glaucoma (D) Signup and view all the answers

What symptom is specifically characteristic of wet beriberi?

Generalized edema (B) Signup and view all the answers

In the context of thiamine deficiency, what biochemical change leads to the symptoms observed?

Accumulation of pyruvic and lactic acid (B) Signup and view all the answers

Which form of infantile beriberi is characterized by sudden cardiac symptoms such as cyanosis and dyspnea?

Acute cardiac (B) Signup and view all the answers

What is a common diagnostic indicator that has been linked to thiamine deficiency?

Elevated blood lactic and pyruvic acid levels (B) Signup and view all the answers

Which lifestyle change can help prevent thiamine deficiency?

Improved milling of rice (D) Signup and view all the answers

What condition results from chronic thiamine deficiency related to brain health?

Ataxia (C) Signup and view all the answers

Which of the following is NOT a common treatment method for diagnosing thiamine deficiency?

Psychological evaluation (C) Signup and view all the answers

What is the primary reason the American Obesity Association defines the 85th percentile of BMI as overweight?

It represents a BMI of 25. (B) Signup and view all the answers

Which of the following is NOT listed as an etiology for obesity?

Metabolic syndrome (B) Signup and view all the answers

What clinical manifestation is common in children with obesity?

Small hands and tapering fingers (B) Signup and view all the answers

Which treatment principle emphasizes the reduction of energy intake in managing obesity?

Limit caloric intake to 1,100-1,300. (D) Signup and view all the answers

Which complication is associated with extreme exogenous obesity?

Pickwickian Syndrome (C) Signup and view all the answers

Which of the following vitamin deficiencies would most likely impact energy metabolism due to its role as a cofactor?

Thiamine (D) Signup and view all the answers

Which dietary restriction is suggested for managing obesity in children aged 10-14 years?

Limit milk intake to no more than 2 glasses per day. (D) Signup and view all the answers

What is the significance of involving family in the treatment of obesity?

They can motivate the child effectively. (C) Signup and view all the answers

Study Notes

Nutritional Disorders

Nutritional pathology is a branch of pathology that investigates how inadequate or excessive nutrition impacts health, leading to diseases.
It combines biochemistry, physiology, and clinical medicine.
Chronic diseases like obesity, heart disease, and diabetes are significantly influenced by diet.
Nutritional deficiencies cause conditions like anemia, rickets, and scurvy.

Basic Principles of Nutrition

Macronutrients:
- Carbohydrates provide energy and support growth and repair.
- Proteins are vital for growth and repair.
- Fats are crucial for energy storage and cellular structure.
- Imbalance leads to energy deficiencies (hypoglycemia) or excess (obesity).
Micronutrients:
- Include vitamins (e.g., A, C, D, and B complex).
- Include minerals (e.g., calcium, iron, and magnesium).
- Deficiencies cause diseases like scurvy (vitamin C deficiency), rickets (vitamin D deficiency), and anemia (iron deficiency).
Water and Electrolyte Imbalance:
- Dehydration and electrolyte disturbances can occur.

Malnutrition

Malnutrition is a pathological state resulting from a deficiency or excess of one or more essential nutrients.
It is often only detected through biochemical, anthropometric, or physiological tests.

Forms of Malnutrition

Undernutrition: Marasmus
Overnutrition: Obesity, Hypervitaminoses
Specific Deficiency: Kwashiorkor, Hypovitaminoses, Mineral Deficiencies
Imbalance: Electrolyte Imbalance

Etiology

Primary Causes:
- Low income and low purchasing power.
- Ignorance and erroneous food habits.
- Scarcity of food supply.
- Overpopulation.
Secondary Causes:
- Obesity, Insulin Resistance, and Diabetes.
- Hepatobiliary Disorders.
- Metabolic and Renal Diseases.
- Diarrhea and Intestinal Malabsorption.
- Infections, especially respiratory infections.

Nutritional Deficiency: Illustration of Pathogenesis

Pathogenesis illustration shows the progression from tissue depletion to physical manifestations.
Key stages include tissue depletion, blood changes, biochemical changes, urinary changes, and clinical manifestations.

Marasmus

Common in the first year of life, related to a form of "balanced starvation".
Conditions include insufficient breast milk, dilute milk mixtures, or lack of hygiene.
Features include wasting, muscle wasting, growth retardation, mental changes, variable subnormal temperature, slow pulse rate, good appetite, often with diarrhea.
Laboratory data shows serum albumin and urinary urea/gm cr levels are usually abnormal.

Kwashiorkor

Occurs between 1–3 years of age.
Characterized by a very low protein intake with some calories.
Often occurs in areas where starchy foods are a main staple.
Features include edema, muscle wasting, psychomotor changes, hair changes, possible flaky paint rash, Noma, hepatomegaly, and anemia, etc.

Treatment of PEM (Protein Energy Malnutrition)

Severe PEM requires immediate hospitalization (1-3 months).
Initial treatment focuses on addressing vitamin deficiencies, dehydration, and infections.
In the acute phase, feeding is gradually restarted once rehydrated and edema resolved. Recovery takes 2-3 weeks.
Rehabilitation involves high-energy feeds (150-200 kcal/kg/day) and usually takes 4-6 weeks.

Prognosis of PEM

Severe PEM occurring early (especially before 6 months) can lead to permanent physical and mental growth impairment.
The first 48 hours are critical, and mortality rates can exceed 50% without proper treatment.
Even with treatment, mortality can still be as high as 10%.
Factors contributing can include endocrine, cardiac or liver failure, electrolyte imbalances, hypoglycemia, and hypothermia.

Obesity

Defined as a generalized, excessive accumulation of fat in subcutaneous and other tissues.
Classification is based on desirable weight standards, with overweight being >10% and obese being >20%.
The CDC recommends focusing on the 85th and 95th percentiles of BMI to identify "at risk" and "obese" levels, respectively.
The American Obesity Association uses BMI 25 for overweight and 30 for obesity in adults.

Etiology of Obesity

Excessive intake of food relative to energy utilization.
Genetic factors.
Psychiatric issues.
Endocrine and metabolic disruptions (rare).
Insufficient exercise or low activity level.

Clinical Manifestations of Obesity

Fine facial features on a heavier, taller child.
Larger upper arms and thighs.
Common knock knees and slightly separated ankles (genu valgum).
Relatively small hands and tapering fingers.
Adiposity in mammary regions.
Pendulous abdomen with striae.
External genitalia often appear small (boys) and menarche usually is not delayed (girls).
Psychological issues are common.
Bone age may be advanced.

Treatment of Obesity

Principle 1: Decrease Energy Intake:
- Initial medical examination to rule out underlying conditions.
- 3-day food recall to assess the diet.
- Dietary planning that avoids sweets, fatty foods, and excessive milk intake. Dietary calorie restrictions and monitoring.
Principle 2: Increase Energy Output:
- Obtain a detailed activity history.
- Increased physical activity.
- Engaging in hobbies to prevent boredom and promote activity.

Complications of Obesity

Pickwickian Syndrome: A rare complication of extreme exogenous obesity, presenting with severe cardiorespiratory distress, alveolar hypoventilation, polycythemia, hypoxemia, cyanosis, and congestive heart failure. Weight reduction is a crucial intervention.
Other complications may include high blood pressure, high cholesterol, metabolic syndrome, type 2 diabetes, and sleep apnea.

Energy-Releasing Vitamins (Thiamine, Riboflavin, Niacin, Pyridoxine)

These vitamins act as cofactors for enzymes involved in energy metabolism.
Deficiency in these vitamins can result in tissue damage in growing tissues like epithelium.
Deficiency symptoms often occur in nerve cells due to the high energy demands.

Thiamine (Vitamin B1) Deficiency

Characterized by beriberi, which has various forms (wet, dry, and infantile).
Biochemical effects include accumulation of pyruvic and lactic acid in body fluids leading to cardiac enlargement, edema, and fatty degeneration.
Degeneration in myelin and axon cylinders result in peripheral neuropathy.
Chronic deficiency may lead to Wernicke's encephalopathy (brain damage) and mental dysfunction.

Riboflavin (Vitamin B2) Deficiency

Characteristic lesions are found in the lips, most commonly as angular stomatitis and cheilosis.
Localized seborrheic dermatitis of the face may also occur.
Other symptoms can include scrotal or vulvar dermatoses, along with ocular symptoms.

Niacin (Vitamin B3) Deficiency (Pellagra)

This deficiency results from diets low in niacin and/or tryptophan.
Clinical features include anorexia, weakness, irritability, sensory disturbances, and a classical triad of dermatitis; diarrhea; dementia.
Dermatitis often appears as a symmetrical erythema, followed by dryness, scaling and pigmentation, with vesicles and bullae.
Location is often on the back of hands, wrists, forearms, and legs (pellagrous glove).

Pyridoxine (Vitamin B6) Deficiency

Loss from refining, processing, cooking, and storing food.
Symptoms can include neuropathic conditions like irritability, depression, and somnolence.
Other conditions can include pellagrous symptoms (due to insufficient niacin) and anemias.

Folic Acid (Vitamin B9) Deficiency

A required component for DNA & RNA synthesis important for cell growth and multiplication.
Newly discovered roles include protection from neural tube defects, heart disease, and colon cancer.
Deficiency is often associated with poor dietary intake (especially in infants/children/pregnant women).
Deficiency symptoms can include megaloblastic anemia, loss of appetite, failure to gain weight, chronic diarrhea, thrombocytopenic hemorrhages, and potential scurvy.

Cobalamin (Vitamin B12) Deficiency

Needed in reactions for producing methyl groups, affecting DNA synthesis, protein synthesis, and cell growth.
Deficiency causes pernicious anemia due to a lack of intrinsic factor secretion by the stomach.
Features can also include megaloblastic anemia , neurological disorders (including ataxia, paresthesias, and coma), smooth red tongue, and excess of methylmalonic acid.

Ascorbic Acid (Vitamin C) Deficiency (Scurvy)

Vitamin C is a necessary component for collagen synthesis and hydroxylation reactions/processes.
Scurvy is characterized by symptoms like bleeding gums, corkscrew hairs, pinpoint hemorrhages (petechiae), and impaired wound healing.
Other issues include osteoporosis, bone fragility, joint pain, and in severe cases, death.

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Description

Test your knowledge on vitamin deficiencies and their clinical manifestations in this nutrition-focused quiz. Questions cover various aspects such as recommended daily allowances and treatment options for deficiencies like riboflavin and thiamine.