Nutrition & Lifestyle

Which of the following are manifestations of thiamine deficiency? (Select all that apply)

• High output cardiac failure

• Encephalopathy

• Thrombocytopenia

• Decreased iron absorption

Answer explanation

Answer

Thiamine deficiency is associated with "wet beriberi," which is a high output cardiac failure, and Wernicke-Korsakoff syndrome encephalopathy, also known as "dry beriberi."

Thrombocytopenia is not normally associated with thiamine deficiency. Patients with a history of chronic alcohol abuse may be at risk of coagulopathies but this is a result of other mechanisms such as hepatic dysfunction.

Ascorbic acid is an important factor in ensuring appropriate iron absorption. Thiamine does not play a role in iron absorption.

High-Yield Core Concept:

 Thiamine deficiency can manifest as cardiovascular disease (high output cardiac failure) or neurologic disorder (Wernicke-Korsakoff syndrome).

 

High-Yield Fast Fact:

 A common thiamine supplementation dose is 100 mg administered intravenously. However, this is insufficient to appropriately treat Wernicke-Korsakoff, which requires 500 mg IV every 8 hours.

A male patient is in the clinic being evaluated for pre-diabetes. To reduce his chances of developing diabetes, you are educating the patient on lifestyle changes, including weight loss. What would the ideal weight be for this man who is six-foot two-inch tall and small- framed? To calculate the IBW, use the following Hamwi formula.

  Males: 106 lbs for the first five ft + six lbs for each  additional inch.

 Females: 100 lbs for the first five ft + five lbs for each additional inch.

 Subtract 10 % for a person with a small frame and add  10 % for a large-framed individual.

• 171 lbs

• 200 lbs

• 190 lbs

• 209 lbs

Answer explanation

Answer

 For males: IBW = 106 pounds for the first five feet of height (60 inches) plus six pounds for each additional inch above five feet.

  The male patient is six feet and two inches tall.

  IBW = 106 lbs + [6 lbs x (1 ft + 2 in)]

  106 lbs + [6 lbs x (12 in + 2 in)]

  106 lbs + (6 lbs x 14 in)

  106 lbs + 84 lbs = 190 lbs

  190 lbs - 10 %

 190 lbs - 19 lbs = 171 lbs

 

High-Yield Core Concept:

 Ideal Body Weight (IBW) has been defined as the level that is consistent with optimal health or that correlates with the lowest mortality and longest longevity.

 

High-Yield Fast Fact(s):

 In determining body frame size, a quick way to figure it out is to place one's thumb and middle finger around one's wrist, right where the person would wear a watch. If one's fingers overlap, the person has a small frame. If they touch, their frame is medium. If the fingers don't meet, the person has a large frame.

An adult female patient who is 5' tall and weighs 120 lbs is being screened for health risks. Which BMI category does the patient fall into?

Underweight — Less than 18.5

Normal Weight — BMI of 18.5 to 24.9

Overweight — BMI of 25 to 29.9

  Obese — BMI of 30 and above

• Underweight

• Normal Weight

• Overweight

• Obses

Answer explanation

Answer

The formula for using pounds and inches is called the English Imperial Formula. BMI is weight (in kilograms) over height squared (in centimeters): BMI = weight (lb) ÷ height² (in²) × 703

  Convert height into inches only.

  (5 ft x 12 inches/ft) = 60 inches

 BMI = [120 ÷ (60 x 60)] x 703

 (120 ÷ 3,600) x 703

 0.033 x 703 = 23.2

 BMI is Normal Weight

 

High-Yield Core Concept:

 Body mass index (BMI) is a simple index of weight for a height that is frequently used in the assessment of nutritional status. A low BMI, or underweight status, is often associated with an increased risk of mortality in seriously ill or hospitalized older adults. Conversely, a high BMI is associated with an increased prevalence or risk of many chronic health conditions.

 

High-Yield Fast Fact(s):

 At an individual level, BMI can be used as a screening tool but is not diagnostic of the body fatness or the health of an individual.

 The formula for BMI was devised in the 1830s by Adolphe Quetelet, a Belgian statistician, and anthropometrist.

A 44-year-old female is beginning a new oral iron regiment for the treatment of iron deficiency anemia. She was instructed also to begin taking a nutritional supplement to enhance iron absorption. Which of the following is the most appropriate recommendation at this time?

• Ascorbic acid

• biotin

• calcium carbonate

• deferoxamine

Answer explanation

Answer

Ascorbic acid, vitamin C, should be supplemented in patients taking oral iron products. Vitamin C facilitates iron absorption via the GI tract and enables mobilization from storage.

Biotin can be supplemented in patients taking iron, but there is no specific indication for its supplementation that will enhance the activity of iron. Therefore, it is not the most appropriate choice.

The combination of calcium carbonate and iron can form insoluble iron complexes and reduce absorption.

Deferoxamine is an iron chelator and would reduce the iron absorption.

High-Yield Core Concept:

 Vitamin C supplementation in patients taking iron products is important to ensure optimal GI absorption.

High-Yield Fast Fact:

 Supplementation of up to 100 mg of vitamin C can increase iron absorption by a factor of four.

The 55-year-old woman who has a BMI of 35.15 would like to achieve her Ideal Body Weight (IBW), and you help her to determine her IBW. You explain that an IBW depends on a person's gender and height. What would the IBW be for this woman who is 5'1" tall and weighs 170 lbs, who is of a medium-size frame? Use the following Hamwi formula.

 Males:    106 lbs for the first five ft + six lbs for each additional inch

 Females: 100 lbs for the first five ft + five lbs for each additional inch

 Subtract 10% for a person with a small frame and add 10% for a large-framed individual.

• 125 lbs

• 106 lbs

• 105 lbs

• 100 lbs

Answer explanation

Answer

 For females: IBW = 100 pounds for the first five feet of height (60 inches) plus five pounds for each additional inch above five feet.

  The female patient is five feet and one inch tall.

  IBW = 100 lbs + (5 lbs x 1) = 105 lbs

 

High-Yield Core Concept:

 Ideal Body Weight (IBW) is a weight that is believed to be maximally healthful for a person, based chiefly on height but modified by factors such as gender, age, build, and degree of muscular development.

  Maintaining ideal body weight is correlated with good health and longer life.

 

High-Yield Fast Fact(s):

 In determining body frame size, a quick way to figure it out is to place one's thumb and middle finger around one's wrist, right where the person would wear a watch. If one's fingers overlap, the person has a small frame. If they touch, their frame is medium. If the fingers don't meet, the person has a large frame.

Which of the following may enhance the efficacy of warfarin?

• Ascorbic acid

• Vitamin B6

• Vitamin E

• Cholacelciferol

Answer explanation

Answer

 Vitamin E may enhance the anticoagulant effect of warfarin by interfering with the vitamin K-dependent process of clotting factor production, as well as inhibition of monocyte expression of tissue factor.

  Ascorbic acid may decrease the efficacy of warfarin.

 Pyridoxine, vitamin B6, does not have any pharmacokinetic or pharmacodynamic interaction with warfarin.

  Cholecalciferol does not have an identified interaction with warfarin.

High-Yield Core Concept:

Patients on chronic warfarin therapy with stable INRs should be cautioned when starting Vitamin E supplementation since it may increase the risk of bleeding. If

supplementation is medically necessary, patients should be followed closely with adjustments to the warfarin regimen to maintain appropriate INR.

High-Yield Fast Fact:

 Similar to oral anticoagulants, vitamin E may enhance the risk of bleeding due to antiplatelet medications, including clopidogrel, prasugrel, and ticagrelor.

A patient was told she has macrocytic anemia and that she could treat this with something over the counter. Which of the following would likely be most indicated?

• Vitamin B3

• Riboflavin

• Vitamin B9

• Thiamine

Answer explanation

Answer

Vitamin B9 is also known as folic acid when deficient can be associated with macrocytic anemia. The same type of anemia can occur with vitamin B12 deficiency.

Vitamin B3 is also known as niacin and is not used for macrocytic or microcytic anemia, but in high doses can be used to lower triglycerides and other lipids.

Riboflavin is also known as vitamin B2 and is used by the body for metabolism of carbohydrates, proteins, and fats.

Thiamine is also known as vitamin B1 and is used by the body for several metabolic reactions of metabolism.

High-Yield Core Concept:

 Vitamin B9 is also known as folic acid when deficient can be associated with macrocytic anemia.

 

High-Yield Fast-Fact:

Cyanocobalamin is also known as vitamin B12 and is also used to treat macrocytic anemia when there is a vitamin B12 deficiency.

A 23-year-old male presenting to the pharmacy requests nutritional biotin supplementation. While he is requesting an oral dosage form, he is willing to try dietary modification first. Which of the following best describes appropriate dietary interventions for biotin? (Select all that apply)

• Egg whites

• Egg yolks

• liver

• kidney beans

Answer explanation

Answer

Egg whites have been associated with decreased absorption of biotin. Egg whites contain the protein avidin, which binds strongly to biotin and prevents absorption. If patients are supplementing their diet with biotin, spacing by at least 2 hours before or after consumption of egg whites should be recommended.

Egg yolks, liver, and kidney beans are appropriate sources of dietary biotin.

Liver contains numerous additional vitamins and can have high concentrations of vitamin A depending on the animal source of this organ meat.

Patients with short-bowel may be at risk of biotin deficiency, and supplementation should be considered.

High-Yield Core Concept:

 While egg yolks are a good source of biotin, egg whites can decrease the absorption of biotin. For patients with clinically significant biotin deficiencies, such as patients with inborn errors of metabolism, should be cautioned of this effect with egg whites and either avoid them in their diets or appropriately space egg white consumption from biotin supplementation.

High-Yield Fast Fact:

  Biotin is a micronutrient that can be added to parenteral nutrition.

You are providing education to clients regarding weight and health. After calculating the Body Mass Index (BMI) for a 55-year-old woman who is 5'1" and 170 lbs, you will encourage the client to lose weight. Referencing the categories below, which category does the client's weight fall into?

Overweight — BMI of 25 to 29.9

Obese, Class I — BMI of 30 to 34.9

Obese, Class II — BMI of 35 to 39.9

Obese, Class III — BMI of 40 or more

• Obese, Class 1

• Obese, Class II

• Obese, Class III

• Overweight

Answer explanation

Answer

The formula for using pounds and inches is called the English Imperial Formula. BMI is weight (in kilograms) over height squared (in centimeters): BMI = weight (lb) ÷ height² (in²) × 703

  Convert height into inches only.

  (5 ft x 12 inches/ft) + 1 inch = 61 inches

  BMI = [170 ÷ (61 x 61)] x 703

 (170 ÷ 3,721) x 703

  0.0456 x 703 = 32.1

  BMI is Obese, Class I

 

High-Yield Core Concept:

 Body mass index (BMI) quantifies adiposity in a height-independent manner, and clinicians can use BMI to prescribe a range of target weights. BMI ranges for overweight status (25.0-29.9), class 1 obesity (30-34.9; low risk), class 2 obesity (35.0- 39.9; moderate risk), and class 3 obesity (≥40.0; high risk) are used to delineate the risk of obesity-related comorbidities.

 

High-Yield Fast Fact(s):

 At an individual level, BMI can be used as a screening tool but is not diagnostic of the body fatness or the health of an individual.

 The formula for BMI was devised in the 1830s by Adolphe Quetelet, a Belgian statistician, and anthropometrist.

You are providing education to patients regarding weight and health. After calculating the Ideal Body Weight (IBW) for a 55-year-old woman who is 5'1", weighs 170 lbs, and is of medium build, you encourage the patient to lose weight. If the woman uses the IBW as her goal weight, how much weight will she need to lose? To calculate the IBW, use the following Hamwi formula.

Males:          106 lbs for the first five ft + six lbs for each additional inch

 Females: 100 lbs for the first five ft + five lbs for each additional inch

 Subtract 10 % for a person with a small frame and add 10% for a large-framed individual.

• 30 lbs

• 50 lbs

• 70 lbs

• 65 lbs

Answer explanation

Answer

 For females: IBW = 100 pounds for the first five feet of height (60 inches) plus five pounds for each additional inch above five feet.

  The female patient is five feet and one inch tall.

 IBW = 100 lbs + (5 lbs x 1 in) = 105 lbs  Current weight - IBW = Weight loss

  170 lbs - 105 lbs = 65 lbs

 

High-Yield Core Concept:

 Ideal Body Weight (IBW) is a weight that is believed to be maximally healthful for a person, based chiefly on height but modified by factors such as gender, age, build, and degree of muscular development. Maintaining ideal body weight is correlated with good health and longer life.

 

High-Yield Fast Fact(s):

 In determining body frame size, a quick way to figure it out is to place one's thumb and middle finger around one's wrist, right where the person would wear a watch. If one's fingers overlap, the person has a small frame. If they touch, their frame is medium. If the fingers don't meet, the person has a large frame.