Bank Of Questions | Clinical Nutrition | Cmt Nta 4 | Clinical Medicine First Year

Bank Of Questions | Clinical Nutrition | Cmt Nta 4 | Clinical Medicine First Year

· Classification of beriberi;

Ø Wet beriberi: the cardiac form.

Ø Dry beriberi: the neurological form.

Ø Infantile beriberi


· Signs and symptoms of wet beriberi;

Ø Heart palpitation, chest pain.

Ø Dyspnoea (breathlessness), a rapid, sometimes irregular pulse and distended neck veins with visible pulsations

Ø The heart is found to be enlarged

Ø Cyanosis

Ø Increased oedema

Ø Severe dyspnoea

Ø Acute circulatory failure and death




· Dry beriberi; Is a condition which affecting chiefly the peripheral nerves

· Signs and symptoms of infantile beriberi;

Ø In the acute form, the infant develops dyspnoea and cyanosis and soon dies of cardiac failure.

Ø Aphonia may occur in more chronic types of beriberi

Ø Wasting, thinness

Ø Vomiting and diarrhoea, and eventually the child becomes marasmic because of deficiency of energy and protein

Ø Oedema occasionally

Ø Convulsion in the terminal stage

· Signs and symptoms in vitamin B2 deficiency ;

Ø Dry scaly skin

Ø  Mouth inflammation and sores

Ø  Sore throat

Ø Eyes Itchy

Ø Light sensitivity


· Early Symptoms of Pellagra;

Ø A person appears poorly malnourished, often weak and underweight

Ø A person may also have diminished sensitivity to gentle touch and sometimes some muscular weakness and tremor

Ø Untreated cases of pellagra may die of the disease


· Features of the skin with Dermatitis are;

Ø Deepening of the pigmentation

Ø Dry skin, scaly and eventual cracked

Ø Desquamation

Ø Rarely the skin may blister

Ø The tongue and other parts of the mouth are often sore, red and smooth




· Symptoms and Signs of Dementia;

Ø Irritability

Ø Loss of memory

Ø Anxiety

Ø Insomnia



· Protein energy malnutrition (PEM): is a series of pathological conditions arising from a deficiency of energy and protein foods.

· PEMcan be classified into three categories;

Ø Gomez classification: Based on weight deficit for age but not the type or duration of the condition.

Ø Wellcome classification: Based on presence or absent of oedema and a minimum body weight above or below 60 percent of the Harvard standard weight for age (fiftieth percentile).

Ø Waterlow: Based on duration of malnutrition.


· Main clinical conditions in classification of malnutrition;

Ø Underweight ;is the mildest form of PEM and can be detected only by checking the weight of the child and by plotting it on the special weight for age chart.

Ø Marasmus;is a form of protein energy malnutrition, due to severe caloric deficit.

Ø Kwashiorkor;is a form of protein energy malnutrition, produced by severe protein deficiency.

Ø Miasmic kwashiorkor;Is the worst form of PEM – it has the combination of severe wasting (like in marasmus) and oedema (like in kwashiorkor).  


· Signs and Symptoms of Kwashiorkor

Ø There is failure of growth but the child is not as severely wasted, as in marasmus

Ø The body weight is 60-80 percentof the standard

Ø The abdomen is swollen (liver enlargement due to fatty infiltration)

Ø The child shows hair changes (hair becomes brown, straight and soft)

Ø Skin rashes (called ‘flaky paint dermatitis’)

Ø The child becomes inactive, apathetic (unconcerned), irritable and is difficult to feed

Ø The child has oedema of lower limbs and other parts of the body

Ø Moonfaced shape 




· Signs and Symptoms of Marasmus:

Ø Remarkable failure of growth –which can be considered the deterioration of the underweight condition

Ø The body weight is less than 60 percent of the standard

Ø Severe muscle wasting with flaccid, wrinkled skin and bony prominence

Ø The child looks awake and hungry and displays what is referred to as ‘old person’s face.’

Ø  Oedema is absent. 

· There are several complications of severe malnutrition, which can make treatment difficult.

Ø Hypoglycaemia (low blood sugar)

Ø Hypothermia (low body temperature)

Ø Diarrhoea

Ø Dehydration

Ø Anaemia

Ø Infections

· Wasting: Weight for age and weight for height are low. It is a rapid decline of weight while height has remained unchanged.

· Stunting: Low height for age. The child has failed to gain height that would correspond with his age. Stunting is caused by chronic under-nutrition (long illness and/or semi-starvation) – that being a reflection of adverse socio-economic condition.

· Body Mass Index (kg/m2)


Ø Below 16.0-     Severe under-nutrition

Ø 16.0 – 17.0-     Moderate under-nutrition

Ø 17.1 – 18.4-     Mild under-nutrition

Ø 18.5 – 24.9-     Good nutritional status

Ø 25.0 – 29.9-     Overweight

Ø 30.0 and above-    Obesity


· General causes of (PEM);

Ø Diseases (Diarrhoea, Malaria, Worm infestation)

Ø Inadequate food intake

Ø Poor socio-economic status

Ø Poor mother education on maternal and child health

Ø Poor health facilities






· Different strategies may includecontrol of PEM;

Ø Incorporate nutrition objectives into development of policies and programmes e.g. RCH, HBC, PMTCT, IMAI and IMCI.

Ø Improving household food security

Ø Protection and promotion of good health

Ø Improving the quality and safety of foods

Ø Protect and promote breastfeeding and complementary feeding

Ø Early treatment of common diseases

Ø Immunization

Ø Growth monitoring

Ø Promoting appropriate diets and healthy lifestyles

· Obesity is a condition which is characterized by the accumulation of excess fat in the body.

· Causes of Obesity;

Ø Sedentary lifestyle; Tendency to take less exercise and do less energetic physical work.

Ø Lack of information or knowledge on healthy eating habits

Ø Ill health and disability; Energy expenditure is reduced by physical incapacity (e.g. back injury).

Ø Psychological factors;Many people tend to eat a lot when they are lonely, worried or depressed.

Ø Social pressure and behavioural factors; Slight changes in behaviour, such as an increase in the number of snacks between meals or change of employment which leads to more eating in a social setting.

Ø Endocrine disorders

Ø Certain drug treatments

Ø Genetic makeup

· There are two ways of classifying obesity;

Ø By fat distribution

Ø Using body weight

· Limitations of BMI

Ø Muscles

Ø Ethnic Groups

Ø Pregnancy

Ø Body Shape



· How To Achieve A Healthy Weight Healthy Eating

Ø Starchy foods

Ø Fruits and vegetables

Ø Dairy foods

Ø Meat, fish and other non-dairy sources of protein (such as beans)

Ø Fat and sugar

Ø Remember to eat meals containing plenty of fibres, and not too much fat or sugar. Eat snacks which are not energy-rich.

Ø Regular ExerciseKeeping physically active is an important way of staying healthy and maintaining a healthy weight.

· Assessment Of Nutritional Status Is Divided Into Four Groups

Ø Dietary history

Ø Anthropometry (the study of human body measurements)

Ø Physical examination

Ø Laboratory tests

· Main Indicators to Assess dietary intake

Ø Amount and type of food eaten

Ø Eating frequency

Ø Food preferences and food dislikes

Ø Food taboos

Ø Eating problems (e.g., lack of appetite, nausea)

Ø Food availability, including indigenous (original) foods

Ø Hygiene in food preparation

Ø Food storage

Ø Where the patient eats

Ø Who prepares meals for the patient

Ø Resources used in food preparation

Ø How the patient acquires food, presence of financial problems

Ø Use of food/nutritional supplements

Ø Do you watch what you eat? Are you on any particular diet?

· MUAC is the circumference of the left upper arm, measured at the midpoint between the tip of the shoulder and the tip of the elbow using measuring or MUAC tape.

· The basic anthropometric measurements are:

Ø Height or length

Ø Weight

Ø Calculation of the body mass index (BMI)

Ø Mid Upper Arm Circumference (MUAC)



· Direct measurement of the concentrations of a nutrient or a metabolite in the body fluid, usually in the serum or urine.

· Indirect Measurement The best way to measure levels of nutrients is to measure its stores because: A decrease in the dietary intake of a nutrient leads to the mobilization of that nutrient from its stores to maintain a normal plasma concentration.

· How to Measure Weight;

Ø Make sure the scale pointer is at zero

Ø Ask the person to take off shoes, hat, and scarves so that they are wearing minimum clothing

Ø Ask the person to stand straight on the center of the balance platform (if the person cannot stand without help, take MUAC)

Ø Record the weight to the nearest 0.1 kg

· How to Measure Height;

Ø Ask the person to remove shoes and headgear, stand erect, and look straight ahead with feet together and knees straight. The heels, buttocks, shoulder blades, and back of the head should touch the wall. (If the person cannot stand without help, MUAC should be taken instead)

Ø Record height to the nearest 0.5 cm.

· How to Measure MUAC for Adults;

Ø Remove clothing that may cover the client’s left arm. If possible, the client should stand erect and sideways to the measurer.

Ø Calculate the midpoint of the left upper arm by first locating the tip of the shoulder with your fingertips. Bend the client’s elbow to make a right angle

Ø Place the tape at zero, which is indicated by two arrows, on the tip of the shoulder and pull the tape straight down past the tip of the elbow. Read the number at the tip of the elbow to the nearest centimeter.

Ø Divide this number by two to estimate the midpoint. A piece of string bent in middle can also be used for this purpose; it is more convenient and avoids damage to the tape. Mark the midpoint with a pen on the arm.

Ø Straighten the client’s arm and wrap the tape around the arm at the midpoint. Make sure the numbers are right side up. Make sure the tape is flat around the skin.

Ø Inspect the tension of the tape on the client’s arm. Make sure the tape has the proper tension and is not too tight or too loose. Repeat any step as necessary

Ø When the tape is in the correct position on the arm with correct tension, read and call out the measurement to the nearest 0.1cm

Ø Immediately record the measurement

· How to Measure MUAC for Children;

Ø Keep your work at eye level. Sit down when possible. Very young children can be held by their mother during this procedure. Ask the mother to remove clothing that may cover the child’s left arm.

Ø Calculate the midpoint of the child’s left upper arm by first locating the tip of the child’s shoulder (arrows 1 and 2) with your fingertips. Bend the child’s elbow to make a right angle (arrow 3). Place the tape at zero, which is indicated by two arrows, on the tip of the shoulder (arrow 4) and pull the tape straight down past the tip of the elbow (arrow 5). Read the number at the tip of the elbow to the nearest centimeter. Divide this number by two to estimate the midpoint. As an alternative, bend the tape up to the middle length to estimate the midpoint. A piece of string can also be used for this purpose. Mark the midpoint with a pen on the arm (arrow 6).


· Recommendations for Healthy Eating During Pregnancy;


Ø Eat starchy foods, such as maize, rice, wheat, millet, sorghum, yams, potatoes and potato products. These foods items should form the main part of the meal.

Ø Pulses, nuts, fish, meat, poultry, milk or eggs, should accompany these foods.

Ø In addition, fruits and vegetables should be available for every meal.

Ø Drink enough safe and clean water at least two liters a day.

Ø Eat frequently

Ø Eating five meals a day is recommended (three main meals plus two snacks).

· Other contributing factors are for children death;

Ø Malaria

Ø Diarrhea

Ø Measles

Ø Neonatal sepsis

Ø Upper respiratory tract infection/acute respiratory tract infection (ARI)

· Feeding Children Ages 2-5 Years;

Ø Offer a variety of foods, taking into consideration the five food groups

Ø Feed family foods for three meals per day

Ø Feed a healthy snack in between meals twice a day (e.g. porridge, milk and boiled or sweet potatoes)

Ø Do not force a child to eat. Make sure children are adequately fed

Ø Care must be taken to ensure that there is no contamination of foods

Ø The child should be taken to the clinic for growth monitoring, supplementation and de-worming

· Feeding of The Sick Child;

Ø Increase intake of nutrient dense foods

Ø Increase feeding frequency

Ø Provide soft foods which are easy to swallow

Ø Increase intake of fluid to prevent dehydration

· Teenagers need additional:

Ø Calories: More energy is needed because they are highly active

Ø Calcium: Calcium is essential for development of strong and dense bones.

Ø Iron: Iron is an essential nutrient needed to help new muscle cells to obtain oxygen for energy production. Deficiency of iron causes anemia which leads to fatigue, confusion, and weakness.

· Nutritional and Health Problems Facing Adolescents;

Ø Undesirable food habits (less fruits, vegetables, depend too much on snacks/junk foods and sweetened colored drinks)

Ø Alcohol abuse and drug use

Ø High morbidity and mortality due to HIV/AIDS

Ø High incidences of diseases, and anemia due to worms

Ø Early adolescent pregnancies increase maternal deaths

· Adults Aged 20-59 Years Recommendation;

Ø Promote nutrition education among adults on health and lifestyle

Ø Supplementation with iron and folic acid

Ø Promote use of reproductive and child health (RCH) services for reproductive age groups

Ø Monitor dietary habits and physical activity due to risk of nutrition-related chronic diseases (NCDs)

Ø Discourage alcohol consumption and smoking 

· Elderly Adults, Aged 60 Years and Above Recommendation;

Ø Foods rich in calcium and vitamin B

Ø Care and support for the elderly

Ø Accessibility of quality health services for the elderly

Ø Monitor- dietary habits, physical active

· Exclusive Breastfeeding: Exclusive breastfeeding means giving a baby breast milk only and no other food or drink, including water, (except prescribed medicines and vitamin or mineral drops).

· Predominant Breastfeeding: Predominant breastfeeding means breastfeeding baby but also giving small amounts of water or non-nutritive drinks.

· Full Breastfeeding: Full breastfeeding means breastfeeding either exclusively or predominantly.

· Bottle Feeding: Bottle feeding means feeding a baby from a bottle, regardless of what is in the bottle. This may include expressed breast milk.

· Artificial Feeding: Artificial feeding means feeding a baby on artificial feeds, and not breastfeeding at all.

· Partial Breastfeeding: Partial breastfeeding means giving a baby some breastfeeds, and some artificial feeds, either milk or cereal, or other food

· Timely Complementary Feeding: Timely complementary feeding means giving a baby other food and fluids in addition to breastfeeding, when it is appropriate, at six months of age.

· Replacement Feeding:  The process of feeding a child, who is not receiving any breast-milk, with a diet that provides all the nutrients the child needs until the child is fully fed on family food.

· Importance of Breastfeeding;

Ø Breastfeeding is important for the short and long term health, survival, growth and development of children.

Ø Both the action of breastfeeding and the composition of breast milk are important.

Ø The action of breastfeeding helps the child’s jaw to develop as well as muscles such as the tongue and muscles of the Eustachian tube.

· Colostrum: is thick and yellowish or clear in color. It is the special breast milk that women produce in the first few days after delivery. After a few days, colostrum changes into mature milk. Mature milk contains foremilk and hind milk.

· Foremilk: is the bluish milk that is produced early in a feed. It contains plenty of protein, lactose, vitamins and minerals and plenty of water but not much fat.

· Hind milk: is the whiter milk that is produced later in a feed. It is rich in fat, which provide about half of the energy of a feed. It is important for the baby to have hind milk, to get enough energy.

· Advantages of Colostrum;

Ø It contains more antibodies and other anti-infective proteins than mature milk. This is part of the reason why colostrum contains more protein than mature milk.

Ø Colostrum has a mild purgative effect, which helps to clear the baby's gut of meconium (the first rather dark stools). This clears bilirubin from the gut, and helps to prevent jaundice.

Ø Colostrum contains growth factors, which help a baby's immature intestine to develop after birth. This helps to prevent the baby from developing allergies and intolerance to other foods.

Ø Colostrum is richer than mature milk in some vitamins - especially vitamin A. Vitamin A helps to reduce the severity of any infections the baby might have.

Ø It is very important for babies to have colostrum for their first few feeds. Colostrum is ready in the breasts when a baby is born. It is all that most babies need before the mature milk comes in.

· Advantages of Breastfeeding;

Ø It costs less than artificial feeding

Ø It helps a mother and baby to bond and develop a close, loving relationship

Ø It helps a baby's development

Ø It can help to delay a new pregnancy

Ø Helps the uterus to return to its previous size. This helps to reduce bleeding, and may help to prevent anemia

Ø Reduces the risk of ovarian cancer, and possibly breast cancer, in the mother.

Ø Provides warmth, closeness and contact, which can help physical and emotional development of the child.

Ø Mothers who breastfed are less likely abandon or abuse their babies.Is environmentally friendly

· Disadvantages of Artificial Feeding;

Ø Artificial feeding may interfere with bonding. The mother and baby may not develop such a close, loving relationship.

Ø An artificially fed baby is more likely to become ill with diarrheal, respiratory, ear, and other infections.

Ø Diarrhea may become persistent

Ø They may get too little milk and may become malnourished, because they get too few feeds, or because they are too diluted. They are more likely to suffer from vitamin A deficiency

Ø An artificially fed baby is more likely to die from infections and malnutrition than a breastfed baby.

Ø They are more likely to develop allergic conditions such as eczema and possibly asthma

Ø They may become intolerant of animal milk, so that the milk causes diarrhea, rashes and other symptoms

Ø A baby may get too much artificial milk, and become obese

Ø  Also a baby may risk of some chronic diseases in the child, such as diabetes, is increased

Ø They may not develop as well mentally, and may score lower on intelligence tests.

Ø A mother who does not breastfeed is more likely to become fertile again and can become pregnant more quickly.

Ø A mother who does not breastfeed is more likely to become anemic after childbirth.

Ø She is more likely later on to develop cancer of the ovary and possibly of the breast.

Ø Artificial feeding may be harmful for children and their mothers.

Ø Breastfeeding is fundamental to child health and survival, and important for the health of women

· A poor suckling position is a cause of many breastfeeding problems including:

Ø Sore and cracked nipples

Ø Unsatisfied babies, who want to feed very often or for a very long time

Ø Frustrated babies who fuss at the breast or refuse to breastfeed

Ø Mothers who believe that they do not have enough milk

· Effect of HIV On Nutrition;

Ø Reduced food intake

Ø Poor absorption of nutrients

Ø Changes in metabolism

Ø Those which cause household food insecurity

Ø Weight loss, muscle wasting and weakened immune system

· Improving Diet Quality for PLHIV;

Ø Use fermented and germinated or sprouted foods. Fermented foods include: Sour milk (mtindi) and togwa

Ø Grains such as maize, millet and sorghum can be germinated

Ø Pulses such as beans and peas can be sprouted

Ø Fermented and germinated/sprouted foods can be easily digested and absorbed

Ø They facilitate digestion and the absorption of other foods

Ø Use spices such as cinnamon, garlic, cardamom, and ginger

Ø It stimulate appetite

Ø Facilitates digestion and absorption of nutrients

Ø Mash or grind food, facilitates swallowing and digestion

Ø Steam food such as leafy vegetables, carrots, sweet-pepper, and eggplant,

Ø helps retain some nutrients

Ø Cook leafy vegetables promptly

Ø Cook immediately after cutting

Ø Cook for a short time and not more than necessary

Ø Eat immediately after cooking to preserve nutrients

· Healthy Lifestyles For PLHIV;

Ø Eat a variety of foods: Whenever possible it is advisable to use locally available foods in preparing balanced meals as they are cheaper and people are used to them. Such foods can include indigenous vegetables, wild fruits and edible insects.

Ø Eat small meals frequently: People living with HIV and AIDS may experience difficulties with food intake, digestion and absorption due to various complications such as oral thrush, nausea, vomiting and diarrhoea.  It is important for PLHIV to eat nutritious smaller portions more frequently throughout the day to meet their nutrient requirement.

Ø Choose food rationally: Foods differ in their nutrient contents.  Choose foods that will provide adequate nutrients. For example, it will be wise to buy and eat nutritious foods such as oranges, groundnuts, eggs or milk instead of a bottle of soda, or other coloured drinks, which will provide only sugar (energy) without other nutrients.

· Important micronutrients for the immune system particularly for HIV include:

Ø Zinc

Ø Iron

Ø Selenium

Ø Vitamin A, C, E and B.

· HIV infected individual needs to:

Ø Increase the amount of energy intake

Ø Maintain dietary intake during illness

Ø Increase nutrient intake for recovery and weight gain

Ø Manage conditions that affect food intake

Ø Maintain food safety and hygiene

Ø Seek medical attention immediately

Ø Manage food and nutrition implications, if on ART

Ø Observe healthy lifestyles

Ø Have enough rest to reduce energy expenditure.


· Scurfy in Infants

Ø Painful limbs

Ø Beading of the ribs

Ø Skin bruising

Ø Suborbital haemorrhage

Ø If teeth have erupted, gingival changes are also seen

· Common symptoms of Rickets in children include:

Ø Child tends to be miserable

Ø Flabby toneless state of muscles that causes a pot-belly

Ø Impairment of normal development i.e. late in reaching all the milestones of early life

Ø Gastro-intestinal upset and excessive sweating of the head

Ø The main signs of the disease are bone deformation including the following features:

Ø A swelling at the growing ends (epiphyses) of the long bones, or a swell at the junction of the ribs with the costal cartilage (‘rickety rosary’)

Ø In infants, the anterior fontanelle closes late

Ø In older children, bossing of the frontal bone, bow-legs

· Complications of Rickets

Ø Deformities of the spine

Ø Changes in the pelvis

Ø May lead to difficulty in childbirth in women who have had rickets in childhood.

· Osteomalacia;is characterized by pain (sometimes severe) in bones, particularly in the pelvis, lower back, and legs.

Ø Spontaneous fractures may be a feature.

Ø Muscle weakness, hypotonia, tetany and convulsion due to hypocalcaemia may occur.

Ø Osteomalacia should not be confused with osteoporosis, a disease of aging, in which decalcification is also a feature.

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