Term
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Definition
disease due to telomerase deficiency
• Autosomal dominant (hTR locus):
– skin dyspigmentation, nail dystrophy, mucosal leukoplakia, premature graying and loss of hair, early dental loss, poor wound healing, skin cancer, thrombocytopenia, pancytopenia, anemia, leukopenia, aplastic bone marrow, severe infections, pulmonary fibrosis, liver cirrhosis, short stature, osteoporosis
• X-linked (DKC1 locus):
– all of the above, + learning difficulties, G.I. tract abnormalities, increased incidence of epithelial and hematological cancers, hypogonadism |
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Term
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Definition
By 2030, 1 in 5 people in US will be older than 65 years.
The 85+ year old population is the fastest growing segment.
Life expectancy from birth has progressively increased – maximal life span held constant.
Women have survival advantage throughout the lifespan. |
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Term
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Definition
GFR down 30-46%
decrease Tubular function
Renal plasma flow decrease ~50%
CrCl = [(140 - age) x (BW)]/[72 x SrCr ]
Multiply x 0.85 for females
BW in kg (LBW or IBW with edema or obesity) |
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Term
| Adrenergic Modulation with age |
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Definition
Sympathetic Nervous System activity increases.
↑ plasma norepinephrine (NE) levels.
↑ rate of NE release.
↑ muscle sympathetic nerve activity.
Decrease in adrenergic receptor responses.
↓ heart rate response to β-agonists
↓ myocardial inotropic response to β-agonists
↓ vasoconstriction to α-agonists
At cellular level, ↓ inhibition (α-) and stimulation (β-) of adenylyl cyclase. |
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Term
| Dementia: DSM IV Criteria* |
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Definition
Impairment in memory plus another area of cognition
Significantly impairs functioning from a previous level
No better explanation
– Delirium
– Axis I |
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Term
| Delirium: DSM IV Criteria* |
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Definition
Decreased awareness and attention
New change in cognition
Acute and fluctuates
Caused by medical condition |
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Term
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Definition
Feature Delirium1 Dementia2
Onset: Acute1 Insidious2
Course Fluctuating1 Stable2
Duration Days1 Months-Years2
Awareness Reduced1 Normal2
Alertness Fluctuates1 Normal2
Illness/Toxicity Present1 ?2 |
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Term
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Definition
Block metabolism of parent cpd.
Ethanol, Fomepizole
Hemodialysis: Acidosis, renal failure
Folate (methanol)
Pyridoxine & thiamine (ethylene glycol) |
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Term
| Cyclic Antidepressants Mechanisms of Toxicity |
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Definition
Na Channel Blockade (Type I)
Anticholinergic
Alpha-adrenergic Blockade
Inhibits Reuptake of Catecholamines |
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Term
| Salicylate Overdose Treatment |
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Definition
Decontamination: Delayed absorption, repeat AC dose?
Alkalinize Blood: IV Bicarbonate
Alkalinize Urine: pH 7.5 to 8.0
Hemodialysis: level > 100 mg/dl, seizures, acidosis
NEED repeat salicylate levels due to very erratic absorption. |
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Term
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Definition
Tinnitus, headache, dizzy, hyperventilation, fever.
Confusion, coma, seizures.
Mixed acid-base disorder
Severe fluid/electrolyte imbalance.
Pulmonary and cerebral edema |
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Term
| Presentation of salicylate toxicity |
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Definition
| Confuseed and deaf, look for initial respiratory alkalosis followed by metabolic acidosis |
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Term
24 yo female found down
Confused, Slurred speech
Nystagmus, diplopia
Pupils 3-4 mm
Depressed reflexes, muscle tone
T 96.5, HR 80, BP 110/70, RR 10
Ataxic
Skin bullae, Pressure sores |
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Definition
Sedative Hypnotic (EtOH, barbs, benzos, etc)
RX: NONE (ABCs), Flumazenil? |
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Term
initially agitated, vomited, progressive SOB
Pupils 2 mm
Drooling, Sweating, Diarrhea
Tearing, Rhinorrhea
Muscle fasciculations
O2 Sat 80%, pulm edema HR 60 |
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Definition
Cholinergic Toxidrome
RX: Atropine, Pralidoxime |
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Term
Agitated, confused, hallucinating
Pupils 5 mm bilaterally
Dry mouth and skin
HR 124, BP 135/88, T 100.8
Decreased bowel sounds
Flushing
Large bladder palpated
+Seizure |
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Definition
Anticholinergic Toxidrome
RX: Physostigmine |
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Term
Agitated, Anxious
Pupils 5mm (mydriasis)
Skin: Diaphoretic
↑ Muscle tone, Tremor
HR 140, BP 170/110, T 38.5
±Hallucinations |
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Definition
Stimulant Toxidrome, meth, PCP
RX: Benzodiazepines |
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Term
Found down, Lethargic
Snoring
Pupils 1-2 mm (miosis)
Resp Rate: 6, HR 55
Decreased bowel sounds
Temp 96 |
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Definition
Opiate Toxidrome
RX: Naloxone |
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Term
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Definition
| Indication: Heavy metals, XR tabs, illicit drug packets. |
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Term
| Toxins that produce an anion gap metabolic acidosis |
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Definition
"M-U-D-P-I-L-E-S"
Methanol, Uremia, DKA, Paraldehyde, Iron/Ibuprofen/INH, Lactic acidosis (e.g., cyanide, metformin ), Ethylene glycol, Salicylates |
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Term
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Definition
| Na – (HCO3 + Cl) = AG (8-12 mEq/L). |
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Term
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Definition
Calc Osmol: 2Na + BUN/2.8 + Glu/18
Gap: Measured - Calculated
Normal gap: -10 to +14 mOsm.
Increased Gap: EG, Methanol, Isopropanol, Ethanol, Lactate, Ketoacidosis, Uremia, Dehydration.
Normal Gap does not exclude toxic alcohol poisoning! (EG 62 mg/dl = 10 mOsm) |
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Term
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Definition
Glucose: R/O stroke 1st
Thiamine?
Naloxone: selective
Flumazenil |
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Term
3. What is the absorption path for medium chain triglycerides?
a. bile micelle, lipase hydrolysis, pinocytosis, lymphatics
b. ATP-ase coupled transport of mono- and di-glycerides
c. lacteal venules, mesenteric veins, and portal vein
d. brush border enzyme hydrolysis and passive diffusion |
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Definition
| lacteal venules, mesenteric veins, and portal vein |
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Term
5. A CF patient receiving a dietary fat intake of 100 grams/day consumes a charcoal
marker at 8:00 AM Monday and a second marker at 8:00 AM Thursday, 72 hours later.
His stool is monitored and a collection begins after the first marker is passed and
concludes with the collection of the stool containing the second marker. A quantitative
analysis by acid hydrolysis reveals a total stool fat of 150 grams. What is the coefficient
of fat absorption? [slide 7]
a. 30%
b. 50%
c. 67%
d. 75% |
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Definition
b. 50%
100 g/day for 3 days = 300 g. 150 passed in stool so 50% absorbed |
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Term
6. On a follow-up visit, Melissa has gained no weight on the 1700 kcal diet. Assuming she remains on a 40% fat diet and gets 5 meals a day, if we increase her intake to 2000 kcal/day, what should her lipase dose per meal be? [slide 21]
a. 20,000 Units
b. 25,000 Units
c. 28,000 Units
d. 32,000 Units |
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Definition
c. 28,000 Units
1600 U lipase/g fat/per meal |
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Term
| Calculating energy needs in CF patients |
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Definition
For child and adolescent:
Use 1.2 x RDA(kcal/kg) for age x weight for 50 th %ile BMI
Wt = BMI x height(m) x height(m)
See table for RDA for age (Slide 25)
Adjust kcal based on weight and growth response
For adult:
BMR x 1.5 to 1.9 based on activity/disease severity estimate
BMR calculated from Harris-Benedict equation
Correction for fat malabsorption may be applied:
93 divided by Coefficient (%) of fat malabsorption if known.
Assume 85% if compliant with enzymes:
93/85 = 1.1 |
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Term
1. Which of the following are predominantly absorbed in the terminal ileum?
A. iron
B. vitamin B12
C. Vitamin A
D. calcium
E. folate |
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Definition
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Term
2. A 29 year old young man with Crohn disease has had multiple small bowel segmental
resections. He has developed abdominal gaseous distention and crampy pain, noisy foul
smelling diarrheal stools that tend to inflame or “burn” his perianal skin and early satiety with
reduced food intake. Culture and parasite examination of the stool and Clostridium difficile
assay are negative. A liquid stool sample is sent for analysis. What combination of stool studies
would be most likely?
A. pH 7, Reducing sugars negative, fat stain positive for neutral fats
B. pH 5, Reducing sugars 3+, fat stain positive for split fats
C. pH 6, Reducing sugars negative, fat stain negative
D. pH 7, Reducing sugars 1+, fat stain positive neutral fats
E. pH 6.5, Reducing sugars negative, fat stain positive split fats |
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Definition
| B. pH 5, Reducing sugars 3+, fat stain positive for split fats |
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Term
6. The colon harbors multiple species of anerobic bacteria that ferment malabsorbed nutrients
and fiber and can salvage some energy and nitrogen in malabsorption states. What is the
potential salvaged fermentation product from malabsorbed carbohydrate reaching the cecum?
A. glutamine
B. short chain fatty acids
C. galactose
D. Vitamin K
E. urea |
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Definition
| B. short chain fatty acids |
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Term
| Segmental nutrient absorption |
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Definition
Salivary amylase in the mouth releases glucose from starch that may be absorbed quickly.
The stomach has a limited direct role in
absorption but gastric acidity facilitates calcium and Vitamin C absorption in the duodenum as well as providing a barrier minimizing bacterial colonization of the
proximal small intestine.
The duodenum is a principal site for calcium, magnesium and iron absorption as well as the fat soluble vitamins A, D, E and K.
jejunum and ileum absorb the majority of
macro- and micro- nutrients and minerals.
ileum: has some additional unique absorptive properties for Vitamin B12 and recycling bile acids back to the liver via enterohepatic circulation.
colon: has a role in water reclamation and harbors bacteria for fermentation salvaging some malabsorbed nutrients as short chain fatty acids and producing Vitamin K. |
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Term
The dietary protein recommendation for patients with diabetic nephropathy is:
Student Response Value
A. 0.5 grams per kilogram body weight or less per day
B. 1 gram per kilogram body weight or less per day
C. 2 grams per kilogram body weight or less per day
D. 3 grams per kilogram body weight or less per day |
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Definition
| 1 gram per kilogram body weight or less per day |
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Term
| ideal pre-pregnancy weight to gain |
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Definition
| 2-5 pounds in the first trimester and about 1 lb. per week during the second and third trimesters for a total of 25-35 lbs |
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Term
| Pregnancy Induced Hypertension |
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Definition
| Body weight reduction is not recommended for mild to moderate hypertension (140- 150/90-99 mmHg). A normal diet without salt restriction is advised. |
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Term
5) Jessica Harris, a 12-year-old female, is self-conscious about her weight. Her mother brings
Jessica to the clinic for an evaluation. Jessica is 12 years old and her BMI-for-age plots at the
87th percentile. Is Jessica’s weight a concern?
A. Yes, Jessica is considered at risk for overweight
B. Yes, Jessica is considered overweight
C. No, Jessica is within her ideal weight range
D. Yes, Jessica is considered underweight |
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Definition
Yes, Jessica is considered at risk for overweight.
95th percentile are categorized as overweight, children who plot above the 85th percentile are categorized as at risk for overweight, and children who plot below the 10th percentile are categorized as underweight |
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Term
| feeding infants in families with a history of allergies |
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Definition
Introduce solids after six months of age
Delay introduction of cow’s milk until one year of age
Delay nuts, fish, and shellfish until three years of age |
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Term
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Definition
Infants to toddlers:
Limit juice intake to 4-6 ounces a day
Children and adolescents:
Limit juice intake to 6-12 ounces a day |
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Term
| One year old and toddler milk intake |
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Definition
| At a year, the toddler needs only about sixteen ounces of milk or milk substitute. A toddler’s maximum intake is recommended to not exceed twenty-four ounces per day |
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Term
4. Sacropenic obesity is related to:
A. Decline in Instrumental Activities of Daily Living (IADL)
B. Decrease in proinflammatory cytokines
C. Increased ghrelin and Neuropeptide Y
D. Bereavement, depression, and dehydration |
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Definition
| Decline in Instrumental Activities of Daily Living (IADL) |
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Term
7. A geriatrics resident counsels a frail elderly woman to increase her vitamin D intake through
food choices. The recommendation included
A. Breakfast cereals
B. Lunch meat
C. Cheeses
D. Bagels |
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Definition
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