Exam 2: NU665A/ NU 665A (New 2024/ 2025
Update) Primary Care of Child II Guide| Qs
& As | Grade A| 100% Correct (Verified
Answers)- Regis
QUESTION
Food protein immunologic enterocolitis syndrome
Answer:
-Inflammation involving the small and large intestine; delayed hypersensitivity reaction
-*Commonly seen in infants at the point where they are introduced to formula or solids; most
common triggers are cow's milk and soy proteins; also rice and oats
-Usually within hours of ingestion - delay of 1-4 hours before onset of severe and repetitive
vomiting and diarrhea; which leads to lethargy, pale, poor growth, FTT, dehydration,
hypotension, and nutrient deficiencies
-Diagnosis - based on clinical history, symptoms, timing, exclusion of other causes, and
symptom improvement with avoidance of offending food; definite diagnosis through oral feeding
challenge done under supervision of a physician
-Management - fluid replacement if vomiting is present; starts with oral rehydration and if
necessary IV fluids; removal of and continuous elimination of the causative food from the diet;
introduce new food one at a time to observe for reactions
-Long term - dietary monitoring with a goal of resolution of the allergy; monitor for nutritional
deficiencies and provide supplements where necessary
-Rule out other things
-Eliminating cow's milk isn't enough
QUESTION
Ulcerative colitis
Answer:
-A chronic disease that is characterized by diffuse inflammation of the rectal and colonic mucosa
,-Fever, weight loss, delayed growth and sexual maturation, arthritis, anorexia, diarrhea, lower
abdominal cramping, LLQ pain, pain increased before stooling and passing flatus, stool with
bright red blood and mucus, nocturnal stooling, oral ulcers, skin lesions
-Complications - growth failure, toxic megacolon, *intestinal perforation, liver disease, sepsis,
cancer of the colon, arthritis, uveitis, malnutrition
-Management - refer for colonoscopy, biopsy, diagnosis and consultation;
QUESTION
Crohn disease
Answer:
-A chronic disease with dysregulated inflammation and cytokine production in the intestinal
tract; any part of the GI tract; inflammation is usually the entire wall of the intestine
-Presentation - fever, weight loss, delayed growth, arthralgias, bloating, early satiety, pain in the
umbilical region and RLQ, may awaken at night, anorexia, malabsorption and lactose
intolerance, diarrhea and pain with stooling, jaundice, oral ulcers
-Complications - *intestinal obstruction with scarring and strictures, growth failure, fistula and
abscesses, perforation and hemorrhage are rare; cholangitis, pancreatitis, pericarditis, arthritis,
and peripheral neuropathy
QUESTION
Nutrition - newborns and infants
Answer:
-Adequate intake of breast milk or infant formula meets all energy needs until 4-6 months of age
-Transitioning to whole cow's milk at 12 months old and continuing until 24 months old to
promote healthy myelination of brain during rapid brain growth period
-Vitamin D is recommended for all breastfed infants and infants on an unfortified formula for
birth until they are one year old
-They should have adequate source of vitamin C after 4-6 months old
-A MV is not recommended for healthy children receiving a well-balanced diet
-Term infants who are breastfed usually have adequate iron until 4-6 months of age; premature or
low birth weight infants who breastfeed require iron supplements for the first 12 months; infants
who are fed cow's milk before 12 months are at risk for anemia; for infants 6-12 months old, iron
fortified cereals and formulas are excellent sources of iron
,-Fluoride - starting at 6 months in nonfluorinated communities; fluorinated water is the best
source who live in communities with it
-At times infants cannot tolerate certain formulas and the PCP must work with the parents to
identify a formula tolerated by the infant; a pediatric dietician may be helpful
-GER may occur - peaks at 4 months - and resolves 12-24 months; during, immediately or hours
after a feeding
-Solids - when the child is 6 months old - sucking patterns have changed, they can sit with some
support, grasp, pick up and bring objects to their mouths, iron stores are being depleted, growth
demands other nutrients, developmental needs are stimulated by new foods, textures, smells
-Whether fed by spoon or self fed, home-prepared foods can meet all nutritional needs
-Packaged baby foods are fine, but look at the calories, fats, sugars and other additives
-One tablespoon for infant
-Do not bottle feed over 12 months, at risk for obesit
QUESTION
Nutrition - early childhood
Answer:
-Growth rate is slower, resulting in decreased energy needs per unit of body weight
-Due to increased size and activity, they need an increased number of calories
-Addition of muscle mass requires more protein
-Vitamin D supplementation is recommended for all children
-If a child is extremely picky or have inconsistent eating behavior - may benefit from a MV plus
mineral supplement
-May show an initial aversion to food and may eat only a few kinds of foods, guidance and
patience - they will learn to eat a variety of foods; be responsive to child's cues for hunger and
satiety, providing the right portions and not insisting they eat everything off their plate
QUESTION
Nutrition - middle chilhood
Answer:
-Energy and protein needs vary depending on body size, growth patterns, and activity levels
-Protein needs increase as they gain muscle mass
-10-18 year old boys - 2200-3200 calories a day; active girls - 1800-2400 calories
, -Poor eating habits and irregular meal schedules place school-age children at risk for deficiencies
in iron, thiamin, vitamin A and calcium; encourage healthy eating habits
-Vitamin D supplementation is recommended; a daily MV may be needed who have an
extremely limited diet and food choices
-Food likes and dislikes carry over from early childhood; may skip lunch at school and snack
with increased screen time; identify healthy snacks and prepared foods that fit a busy family
schedule
-High fat, high-calorie, low-nutrient snacks should be avoided on a daily basis and be a limited
part of a child's diet
QUESTION
Vegetarian and vegan
Answer:
-Vitamin B12 supplementation is required for children eating a vegan diet
-Vegan diets can also be deficient in protein, iron, calcium, zinc, riboflavin and vitamin D
-Iron and zinc may need to be supplemented in a vegetarian diet; combine iron with vitamin C
-Referral to a nutritionist and behavioral/mental health specialist is indicated if growth failure or
vegetarianism as an eating disorder
QUESTION
Nutrition - Adolescents
Answer:
-High levels of energy are needed to support the rapid growth rate
-Additional caloric intake if they play sports
-Adolescents with irregular eating habits or those who eat a diet with a limited variety of foods
are at risk for deficiencies
-Females are at risk for calcium and iron deficiency with menstruation begins
-Vitamin D supplementation is recommended for all
-They have erratic eating behaviors, skip meals, eat high-fat, high caloric, low nutrient snack
foods and consume calories late in the day
-A vegetarian diet at a young age can develop lifelong healthy eating habits with lower risk of
obesity and chronic diseases
-Pregnancy - eat a varied and healthful diet; more at risk for premature, low birth weight and
chronic illness, disabilities or death; prenatals and a mineral supplement
