Preventive meds prof i review

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MBBS 2013 BATCH

PREVENTIVE MEDICINE PROF. I EXAM REVIEW 2015

REVISED BY ::

BHAGATH M S RAJEEV BISWAS

PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

CHAPTER 1 NUTRIENTS AND ENERGY REVIEW QUESTIONS 1. 2. 3. 4. 5. 6. 7.

SUBSTANCE THAT PROVIDE ENERGY. WHAT KIND OF SUBSTANCE PROVIDE HOW MUCH ENERGY. PROTEINS, LIMITED AMINO ACID SUPPLEMENTARY ACTION OF PROTEINS BV, DIGESTIBILITY CO-EFFICIENT, NPU, PER PROTEINS - FUNCTIONS FAT a. b. c.

8.

ESSENTIAL FATTY ACID (EFA) FUNCTIONS SOURCE OF FAT (for mcq) <sufflower,fish oil etc>

CARBOHYDRATES a. CLASSIFICATION b. FUNCTION

9. WATER SOLUBLE VITAMINS – INCLUDING HOW MANY, <must know the scientific names> 10. THIAMINE <1st paragraph must be read> a. b. c.

LOSSES FUNCTION OF THIAMINE <for long question> DEFICIENCY <for mcq> (which part get affected)

11. RIBOFLAVIN, NIACIN, FOLIC ACID and VITAMIN C a. b.

FUNCTION <for long question> DEFICIENCY <for mcq>

12. FAT SOLUBLE VITAMINS (which vitamin belongs to fat soluble vitamin) <for mcq> 13. RETINOL a. b. c.

SOURCE FUNCTION DEFICIENCY

14. VITAMIN D a. b.

FUNCTION (Ca absorption point) DEFICIENCY

15. VITAMIN E – FUNCTIONS 16. MINERALS – Calcium and Iron a. b.

FUNCTION DEFICIENCY

17. CALCIUM a. b. c.

SOURCES ABSORBTION LOSSES

18. IRON – SOURCES 19. DEFICIENCY OF IODINE CAUSE WHAT KIND OF DISEASE ? 20. DIFICIENCY OF ZINC

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PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

1. SUBSTANCE THAT PROVIDE ENERGY.  CARBOHYDRATES (4kcal/g, -16.7 kJ/g)  MONOSACCHARIDES (such as glucose, fructose) <mostly uses BRAIN>  DISACCHARIDES (such as sucrose, lactose)  OLIGOSACCHARIDES  POLYSACCHARIDES (such as starch, glucose, cellulose)  PROTEINS (4kcal/g , -16.7 kJ/g)  Organic compounds that CONSIST OF THE AMINO ACIDS JOINED BY PEPTIDE BOND  FATS (9kcal/g , -37.7 kJ/g)  Are UNBRANCHED HYDROCARBON CHAINS, connected by single bonds alone (saturated fatty acids) or both double and single bond (unsaturated fatty acids)  ESSENTIAL FATTY ACID  The body does not manufacture certain fatty acid

2. WHAT KIND OF SUBSTANCE PROVIDE HOW MUCH ENERGY.  CARBOHYDRATES - 4kcal/g, (-16.7 kJ/g)  PROTEINS - 4kcal/g , (-16.7 kJ/g)  FATS - 9kcal/g , (-37.7 kJ/g)  ETHANOL (grain alcohol) – 7kcal/g (-29.3 kJ/g)

3. PROTEINS, LIMITED AMINO ACID PROTEINS o o o o o o o

Are large molecular MADE OF NITROGEN CONTAINING AMINO ACID that are united together by PEPTIDE LINKAGE In adults, approx. 16% OF THE BODY WEIGHT is attributable to proteins Next to water, protein is the major component of body tissues. Are indispensable constituents of living protoplasm as they participate in all vital processes. Are MACROMOLECULES consist of amino acid chains. A total of 22 Amino Acid are known to be physiologically produced by humans.

LIMITED AMINO ACID The essential amino acid that is in shortest supply in a given food item is known as LIMITING AMINO ACID.  For example the limiting amino acid in wheat is LYSINE and in pulses is METHIONINE. The quality of vegetable proteins in a vegetarian diet can be improved by providing a suitable combination of vegetable proteins.

4. SUPPLEMENTARY ACTION OF PROTEINS A relative lack of particular amino acid in one protein can be compensated by simultaneous consumption of another protein, which contains that limiting amino acid. This is known as SUPPLEMENTARY ACTION.

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PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

5. BV, DIGESTIBILITY CO-EFFICIENT, NPU, PER 1) BIOLOGICAL VALUE (BV) = Nitrogen retained X

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2)

DIGESTIBILITY CO-EFFICIENT = Nitrogen absorbed X

3)

NET PROTEIN UTILIZATION (NPU) = Retained Nitrogen X PROTEIN EFFICIENCY RATIO (PER) =

4)

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6. PROTEINS – FUNCTIONS The functions of proteins are :: a) Proteins are important for body building, growth, repair and maintenance of body tissues; b) Proteins are required for the synthesis of plasma proteins, hemoglobin, enzymes and hormones; c) Proteins like collagen, actin and myosin form the structural tissues; d) Proteins act as transport carriers for many molecules like iron, hemoglobin, lipids etc.

7. FAT a.

ESSENTIAL FATTY ACID (EFA)

b. FUNCTIONS

c. SOURCES

a) ESSENTIAL FATTY ACID (EFA) Certain unsaturated fatty acid cannot be synthesized in the body. And must be acquired from diet. o Are commonly found in plant and fish oils. o

The EFA requirement is 3-6% of the total energy intake depending on the age and physiological status of the individual.

b) FUNCTION OF FAT ďƒ˜ Fats are concentrated sources of energy providing about 37.7 KJ/g or 9 Kcal/g.

Note the calculation.

ďƒ˜ Fats serves as vehicle for fat soluble vitamins (A,D,E and K) ďƒ˜ Fats are structural components of cell and cell membrane ďƒ˜ Are sources of EFA. Linoleic acid and arachindonic acid are precursors of prostandins which are required for a wide variety of metabolic functions ďƒ˜ Their nutritional significance, fats improve the palatability of diet, delay gastric emptying & raise the caloric density. ďƒ˜ Some fats can converted to biologically active compounds such as steroid hormones, interleukins, thromboxanes and prostaglandins and bile acids (from cholesterol)

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PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

c) SOURCE OF FAT  Animal Sources : milk, milk product (ghee, butter), lard, egg and fish oil. Animal fat are generally poor sources of essential fatty acids with exception of certain marine fish such as cod liver oil and sardine oil are good source of RETINOL and CHOLECALCIFEROL.

 Vegetable Sources : edible oils such as groundnut, gingely, mustard, cottonseed, safflower, rapeseed, palm, and coconut oil. Except coconut oil, all are rich source of essential fatty acids, but they lack RETINOL and CHOLECALCIFEROL except red palm oil which is rich in carotenoids.

8. CARBOHYDRATES a. CLASSIFICATION

b. FUNCTION

a. CLASSIFICATION

MCQ :: Which kind belongs to ?

(A) AVAILABLE CARBOHYDRATES  digested in the upper gastrointestinal tract, absorbed and utilized.  sub-classified as: (i) Monosaccharides (glucose, fructose and galactose) (ii) Disaccharides (lactose, sucrose and maltose) (iii) Polysaccharides (starch, dextrin and glycogen ) (B) DIETARY FIBRE  difficult to digest  cellulose, hemicellulose, gums, pectins, etc b. FUNCTION OF CARBOHYDRATES  The most significant and cheapest source of energy in the diet (4Kcal/g)  Glycogen resources are in a state of dynamic exchange with the energy balance.  Protein sparing action  A constant supply of carbohydrates has a protein sparing action and proteins are not required to be broken down for energy.  The important function of increasing the brain exclusively uses glucose for its functioning.  Fibre has faecal bulk, stimulating peristalsis and blocking cholesterol synthesis in the liver.  Contribute to 60-70% of total energy. (about 360-400g carbohydrates for a 2400 Kcal diet)

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PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

9. WATER SOLUBLE VITAMINS – INCLUDING HOW MANY, <must know the scientific names> Must know the scientific names of each

 Water soluble vitamins  Vitamin B1 (THIAMINE)  Vitamin B12 (CYANOCOBALAMIN)  Vitamin C (ASCORBIC ACID)  Riboflavin  Niacin (NICOTINIC ACID & NICOTINAMIDE)  Folic Acid (FOLATE or PTEROYL GLUTAMIC ACID)

10. THIAMINE <1st paragraph must be read> a. LOSSES

b. FUNCTION OF THIAMINE <for long question>

c. DEFICIENCY <for mcq> (which part get affected)

THIAMINE (Vitamin B1) o WATER SOLUBLE VITAMIN o A crystalline substance. o

Readily soluble in water.

o

Rapidly destroyed by heat in neutral or alkaline solutions.

o

Resistant to heat up to 120° C in acid solution.

o

Mainly excreted in urine.

o

PRESENT IN THE BODY MOSTLY AS THIAMINE PYROPHOSPHATE (TTP).

o

TPP is the active form of thiamine in the body.

TO READ

MCQ :: How many percentage ?

a. LOSSES o Milling of cereals below an extraction rate of 75% reduces the content of thiamine. o Thiamine is readily soluble in water, so considerable amounts maybe lost when foodstuffs are cooked in an excess of water which is afterwards discarded. o

But if baking powder is used, or if soda is added in the cooking of foodstuffs, almost all vitamins may be destroyed.

o

NO TOO MUCH FIBER CONTENT.

b. FUNCTIONS o Acts as a coenzyme in many metabolic reactions o Being the oxidative decarboxylation of pyruvic acid o Essential for the health of the nerve tissue and for normal cardiac and gastro-intestinal functions.

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PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

c. DEFICIENCY

MCQ :: Which parts get affected?

o Thiamine deficiency causes Beriberi and Wernicke-Korsakoff psychosis.

BERIBERI o Three forms of Beriberi i. DRY Beriberi (NEUROLOGICAL) ::  Anasthetia of skin over tibia ii. WET Beriberi (CARDIAC) ::  High Output Cardiac Failure, Bounding pulse, Warm extremities, peripheral oedema, Cardiac dialation iii. INFANTILE Beriberi ::  Occurs in first few months of life, if the diet of mother is deficient in thymine

WERNICKE-KORSAKOFF PSYCHOSIS. o Chronic alcoholics with poor diet.

11. RIBOFLAVIN, NIACIN, FOLIC ACID and VITAMIN C a. FUNCTION <for long question>

b. DEFICIENCY <for mcq>

RIBOFLAVIN a. FUNCTIONS  Riboflavin is involved in oxidation-reduction reactions within the cells.  Promotion of normal growth  Assisting synthesis of steroids, RBC and glycogen  Maintenance of mucous membranes, eyes and the nervous system  Aiding iron absorption b. DEFICIENCY i.

Cheilosis, Angular stomatitis, Glossitis, Magenta tongue, Nasolabial seborrhea, Genital (scrotal or vulval) dermatosis.

ii.

Severe deficiency :: People at a higher risk (anorexia nervosa and chronis dieters)

iii.

Secondary nutrient deficiencies :: Hypochromic anemia, Vitamin B6, deficiency and pellagra.

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PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

NIACIN a. FUNCTIONS  Incorporated into the pyridine nucleotide coenzyme and other coenzyme  Involved in numerous oxidoreductase reactions (glycolysis, fatty acid metabolism, tissue respiration and detoxification) b. DEFICIENCY  PELLAGRA This is characterized by the three ‘D’ s i. DERMATITIS :: o skin exposed to sunlight gets inflamed, that progresses to pigmentation, cracking and peeling ii. DIARRHOEA :: o accompanied by inflamed scarlet tongue iii. DEMENTIA :: o mild confusion and disorientation

FOLIC ACID a. FUNCTIONS o The play an important role in synthesis of purines, pyrimidines, glycine and methionine. o It is essential for synthesis of DNA. o It is a potent anti-anemia factor in the treatment of megaloblastic anemia of malnutrition, pregnancy and malabsorption. o It is also effective in treatment of pernicious anemia. b. DEFICIENCY o Megaloblastic anemia o Depression o Insomnia o Forgetfulness o Irritability o Dementia o Neural tube defects o Hyper-homocysteinaemia <high level of folate in blood>

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PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

VITAMIN C (ASCORBIC ACID) a. FUNCTIONS o It is a powerful reducing agent, and is essential for many oxidation reduction reactions. o It is required for the formation of collagen, so it is necessary for the formation and maintenance of normal structure of the connective tissue, bones, tendons, skin, teeth and capillaries. o It is important for Hydroxylation of Dopamine to noradrenaline. o Enhances absorption Iron by converting ferric(Fe3+) to ferrous(Fe2+) ions. o It has an anti-oxidating property. o Influence the maturation of RBC, synthesis of bile and metabolism of drugs and carcinogens by the liver. b. DEFICIENCY o SCURVY :: symptoms includes spongy and bleeding gums, bones, and capillaries ,perifollicular hemorrhages

12. FAT SOLUBLE VITAMINS (which vitamin belongs to fat soluble vitamin) <for mcq> Must know the scientific names of each

 Fat soluble vitamins  Vitamin A (RETINOL)  Vitamin D (CALCIFEROLS)  Vitamin E (TOCOPHEROL)  Vitamin K o Vitamin K1 (PHYLLOQUINONE) o Vitamin K2 (MENAQUINONE)

13. RETINOL (VITAMIN A) a. SOURCE

b. FUNCTION

c. DEFICIENCY

a. SOURCE o Meat, liver, kidneys, milk, fish and eggs. o Cabbage (Carotenoids), Yellow-orange vegetables and fruits (β-Carotenoids) b. FUNCTION o It is vital for the formation of retinal pigments rhodopsin in rods of the retina. o It is essential for integrity of cellular structure. o It had a role in immune defense mechanism of the body.

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PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

o It has an anti-oxidant property of free radical scavenging. c. DEFICIENCY o It leads to ocular and extra ocular manifestation. o Retinol deficiency leads to impairment of dark adaption or night blindness. o Ocular manifestation resulting from Vitamin A deficiency are termed as Xerophthalmia

14. VITAMIN D (CALCIFEROLS) a. FUNCTION (Ca absorption point)

b. DEFICIENCY

a. FUNCTION o Regulates the absorption and excretion of calcium from the small intestine. o Plays an essential part in the mechanism for mineralizing bone. o It is consider as hormone rather than vitamin. b. DEFICIENCY o Rickets in children o In adult, osteomalacia

15. VITAMIN E (TOCOPHEROL) – FUNCTIONS FUNCTIONS  It has a strong anti-oxidant property  Protects cell membrane and lipo-proteins against damage from free radicles  It maintains cell membrane integrity.  It has a role in DNA and prostaglandin synthesis.

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PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

16. MINERALS – Calcium and Iron a. FUNCTION

b. DEFICIENCY

CALCIUM  Bone formation o More than 99% of body calcium is found in bone, helps in providing structural rigidity to bones and teeth.  Nerve conduction

FUNCTION

o It is responsible for the maintenance of optimum excitability of the nervous and the muscular tissue.  Blood coagulation o It has an important role in coagulation of blood as factor IV.  As cofactor o It act as cofactor for a number of enzyme. Eg :: lipase

DEFICIENCY

 Osteoporosis - abnormal thinning of bones

IRON FUNCTION

 It is component of Hemoglobin and Myoglobin  It is an essential component of Heme  It constitute important enzyme like cytochrome, catalase, peroxides etc  It serves in oxygen transport and cellular respiration.  Involved in cellular immune response DEFICIENCY

 Anemia

17. CALCIUM a. SOURCES

b. ABSORPTION

c. LOSSES

a. SOURCE Milk, and milk products, Ragi, Fish, Dry Fruits, Betel leaves, Pulses and Tofu. b. ABSORPTION  Calcium in food is not uniformly available in the body, with presence of oxalic acid in foods which forms insoluble calcium oxalate. c. LOSSES  Mainly in faeces.

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PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

18. IRON – SOURCES SOURCE :: Two main groupsi.

HAEM IRON Sources: Essentially non-vegetarian sources of iron. Eg: meat, fish, and eggs.

ii.

NON-HAEM Sources: These are vegetarian sources such as Cereals, dark green leafy vegetables, pulses, nuts, and dry fruits. Absorption of iron from these foods is only 1 to 20%.

19. DEFICIENCY OF IODINE CAUSE WHAT KIND OF DISEASE ? GOITER

20. DEFICIENCY OF ZINC  Severe deficiency cause growth retardation, failure to thrive, delayed sexual maturation.  It can impair cellular immune mechanism.  They can cause neuro-psychiatric changes, dermal lesions, diarrhea and alopecia.

CHAPTER 2 MAJOR FOODS AND THEIR NUTRITIVE VALUE REVIEW QUESTION 21. PROTEIN – CHARACTERISTICS (DIFFERENT KIND OF BEANS, LIMITED AMINO ACID)

21. PROTEIN – CHARACTERISTICS

(DIFFERENT KIND OF BEANS, LIMITED AMINO ACID)

 Cereals are moderate source of protein  Wheat proteins are deficient in LYSINE and maize in TRYPTOPHAN.  Pulse protein on the other hand is rich in this two element

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PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

CHAPTER 3 NUTRIENTIONAL DEFICIENCY DISEASES OF PUBLIC HEALTH IMPORTANCE REVIEW QUESTIONS 22. PROTEIN ENERGY MALNUTRITION – CLASSIFICATION AND CLINICAL FEATURES a. MARASMUS b. KWASHIORKOR 23. IODINE DEFICIENCY DISORDER – PREVENTION AND CONTROL

22. PROTEIN ENERGY MALNUTRITION – CLASSIFICATION AND CLINICAL FEATURES a. MARASMUS

b. KWASHIORKOR

PROTEIN ENERGY MALNUTRITION (PEM) :: 

Malnutrition is a range of conditions occurring when intake of one or more nutrients doesn’t meet requirements.

Is a malnutrition resulting from the deficiency of protein and/or energy in diet.

Is an important nutritional problem among preschool age children. This leads to various degrees of growth retardation.

Prevention is to fight poverty and ignorance.

It is a complex problem involving each of the social, economic, educational, political, administrative, medical and health dimensions.

Things like health promotion, specific protection, early diagnosis and treatment, and rehabilitation.

CLINICAL MANIFESTATION a. MARASMUS: 

Clinical features are seen commonly in children aged less than 5 years.

It is characterized by growth retardation, wasting of muscles and subcutaneous fat.

b. KWASHIORKOR: 

Clinical features are commonly seen in children aged 2 to 5 years of age.

It is characterized by oedema, growth retardation, muscular wasting, retention of subcutaneous fat, and psychomotor changes.

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PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

23. IODINE DEFICIENCY DISORDER – PREVENTION AND CONTROL    

Use of iodized salt or oil. Iodine monitoring Man power training Mass communication

CHAPTER 4 FOODBORNE ILLNESS AND FOOD POISONING REVIEW QUESTIONS 24. HOW MANY TYPES OF FOOD BORNE ILLNESS ? 25. WHAT KIND PERSON ARE ARREST FOR FOOD BORNE ILLNESS? (who is at risk for food-borne illness?) 26. FOOD POSIONING a. DEFINITION b. CLINICAL MANIFESTATION 24. HOW MANY TYPES OF FOOD BORNE ILLNESS ?

There are two main types of foodborne illnesses: a. Intoxication or “Poisoning” b. Infection.

25.

WHAT KIND PERSON ARE ARREST FOR FOOD BORNE ILLNESS? (who is at risk for food-borne illness?)

o Infant and Children :: because their immune system that help them fight disease are not as fully developed as those of adults. o People with Cancer, AIDS, other other disease are more likely to get a food borne illness. o Pregnant woman and their fetus are more risk of food borne illness.

26. FOOD POSIONING a. DEFINITION

b. CLINICAL MANIFESTATION

o Any illness arising from eating contaminated foods. Also known as foodborne illness o Infectious diarrhea or gastroenteritis, food poisoning is generated by a variety of microorganisms including bacteria, viruses, and parasites. CLINICAL MANIFESTATION  Severe diarrhea  Fever  Cramping  Abdominal pain  Flu-like symptoms  Vomiting  Diarrhea. 13

PREVENTIVE MEDICINE- PROF. I - 2015

2013 BATCH EXAM REVIEW

UNIT 3 OCCUPATIONAL HAZARD AND PREVENTION REVIEW QUESTIONS 27. DEFINITION OF BOHS & OBJECTIVES. 28. VIBRATION – CLINICAL PRESENTATION & DIAGNOSIS (WHAT VWF INCLUDES?)

27.DEFINITION OF BOHS & OBJECTIVES. BOHS are an essential service for protection of people’s health at work, for promotion of health, well being and work ability, as well for prevention of ill health and accidents.

OBJECTIVES i. Available To All Working People. ii. Addressing To Local Needs. iii. Adapted To Local Conditions. iv. Affordable To Providers And Clients. v. Organized By The Employer For Employees. vi. Provided By Public Sector For The Self-Employed And The Informal Sector. vii. Supported By Intermediate Level Services.

28. VIBRATION- CLINICAL PRESENTATION & DIAGNOSIS (WHAT VWF INCLUDES) The hallmark sign of clinical disease related to hand-arm vibration is a well-delineated patchwise blanching of the fingers, occurring at sites of greatest exposure of the hands or the whole body to a cold environment. VWF signs and symptoms are a subset of those designated by the acronym HAVS. VWF includes :: 1. White finger 2. Peripheral neuropathy, with or without increased cold sensitivity 3. Distal compressive and demyelinating neuropathies of digital nerves, the median nerve at the carpel tunnel, and less plausibly, the ulnar nerve; 4. Musculoskeletal disturbances, such as weakness, lancinating forearm pain, and bone and joint degeneration.

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