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The Disaster Cycle

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Learn Nutritional Assessment (SDL Exercise)

Nutritional Assessment Game

Welcome, medical student! Test your knowledge on nutritional assessment methods.

📏 Anthropometry

🔬 Biochemical Tests

🩺 Clinical Exam

🍎 Dietary Assessment

🌍 Ecological Factors

Choose a Scenario, !

Select a nutritional assessment challenge to begin:

🔬 Biochemical Tests

Interpret lab results for a patient with vague symptoms.

📏 Anthropometry

Classify nutritional status of children using provided data.

🍎 Dietary Assessment

Analyze a lactating mother's diet, taboos, and intake.

🌍 Ecological Factors

Identify nutritional issues from family food purchases.

🩺 Clinical Exam

Diagnose a suspected vitamin deficiency from lab results.

📝 Dietary Planning

Create a tailored diet plan for a pregnant woman.

Scenario 1: The New Patient with Vague Symptoms

Time Left: 10:00

A 55-year-old female presents to your clinic complaining of persistent fatigue, weakness, and occasional dizziness. She states she has been feeling "run down" for the past few months. On general physical examination, you note her skin appears slightly pale, but there are no obvious specific physical signs of deficiency like angular stomatitis or Bitot's spots. She denies any recent changes in diet, but her recollection is vague.

Selected Primary Method: Biochemical Tests

Imagine the following laboratory results come back for this patient. Your task is to interpret these key results to identify any potential nutritional deficiencies and suggest a primary nutritional diagnosis.

Patient Lab Results:

Test	Result	Reference Range
Hemoglobin (Hb)	9.8 g/dL	12.0 - 15.5 g/dL
Serum Ferritin	10 ng/mL	20 - 200 ng/mL
Serum Vitamin B12	180 pg/mL	200 - 900 pg/mL
Serum Folate	8 ng/mL	> 3 ng/mL
Serum Albumin	3.9 g/dL	3.5 - 5.0 g/dL
Fasting Blood Glucose	95 mg/dL	70 - 99 mg/dL

What is your interpretation of these results regarding her nutritional status? Which specific deficiencies are indicated, and what would be your immediate nutritional assessment conclusion?

AI Expert Explanation:

Scenario 2: Screening Children in a Community Health Camp

Time Left: 10:00

You are part of a public health team conducting a health camp in a rural village. Your goal is to identify children aged 1-5 years who are at risk of malnutrition (stunting or wasting) on a large scale, quickly and cost-effectively, so they can be referred for further intervention. You have limited time and resources.

Selected Primary Method: Anthropometry

You have collected anthropometric data for 10 children. Your task is to classify their nutritional status based on the WHO Child Growth Standards.

Child Anthropometric Data:

*The image above shows the raw anthropometric data for 10 children.*

WHO Child Growth Standards Links (for Z-score calculation):

• Weight-for-Length/Height
• Length/Height-for-Age
• Weight-for-Age

Z-score Classification Criteria (for your reference):

• Wasting/Overweight/Obesity (Weight-for-Length/Height):
  • Severe Wasting: < -3 SD
  • Moderate Wasting: ≥ -3 SD and < -2 SD
  • Normal: ≥ -2 SD and ≤ +1 SD
  • At Risk of Overweight: > +1 SD and ≤ +2 SD
  • Overweight: > +2 SD and ≤ +3 SD
  • Obese: > +3 SD
• Stunting (Length/Height-for-Age):
  • Severe Stunting: < -3 SD
  • Moderate Stunting: ≥ -3 SD and < -2 SD
  • Normal: ≥ -2 SD
• Underweight (Weight-for-Age):
  • Severe Underweight: < -3 SD
  • Moderate Underweight: ≥ -3 SD and < -2 SD
  • Normal: ≥ -2 SD

Enter Classification for the 10 Children:

ID	Age (months)	Sex	Weight (kg)	Height/Length (cm)	Wasting/Overweight/Obesity Status	Stunting Status	Underweight Status
1	24	M	9.5	80	SelectSevere WastingModerate WastingNormalAt Risk of OverweightOverweightObese	SelectSevere StuntingModerate StuntingNormal	SelectSevere UnderweightModerate UnderweightNormal
2	36	F	11.0	90	SelectSevere WastingModerate WastingNormalAt Risk of OverweightOverweightObese	SelectSevere StuntingModerate StuntingNormal	SelectSevere UnderweightModerate UnderweightNormal
3	18	M	7.8	75	SelectSevere WastingModerate WastingNormalAt Risk of OverweightOverweightObese	SelectSevere StuntingModerate StuntingNormal	SelectSevere UnderweightModerate UnderweightNormal
4	12	F	6.0	68	SelectSevere WastingModerate WastingNormalAt Risk of OverweightOverweightObese	SelectSevere StuntingModerate StuntingNormal	SelectSevere UnderweightModerate UnderweightNormal
5	30	M	10.5	85	SelectSevere WastingModerate WastingNormalAt Risk of OverweightOverweightObese	SelectSevere StuntingModerate StuntingNormal	SelectSevere UnderweightModerate UnderweightNormal
6	48	F	13.0	95	SelectSevere WastingModerate WastingNormalAt Risk of OverweightOverweightObese	SelectSevere StuntingModerate StuntingNormal	SelectSevere UnderweightModerate UnderweightNormal
7	6	M	5.5	60	SelectSevere WastingModerate WastingNormalAt Risk of OverweightOverweightObese	SelectSevere StuntingModerate StuntingNormal	SelectSevere UnderweightModerate UnderweightNormal
8	42	F	12.0	90	SelectSevere WastingModerate WastingNormalAt Risk of OverweightOverweightObese	SelectSevere StuntingModerate StuntingNormal	SelectSevere UnderweightModerate UnderweightNormal
9	15	M	7.0	70	SelectSevere WastingModerate WastingNormalAt Risk of OverweightOverweightObese	SelectSevere StuntingModerate StuntingNormal	SelectSevere UnderweightModerate UnderweightNormal
10	20	F	8.5	75	SelectSevere WastingModerate WastingNormalAt Risk of OverweightOverweightObese	SelectSevere StuntingModerate StuntingNormal	SelectSevere UnderweightModerate UnderweightNormal

Scenario 3: Investigating Dietary Patterns and Taboos

Time Left: 10:00

You are assessing Smt. Meena, a 25-year-old woman (50 kg) from the Irula tribe in South India, who recently had a normal vaginal delivery and is exclusively breastfeeding. She is illiterate and an agricultural laborer. You conducted a 24-hour dietary recall.

Selected Primary Method: Dietary Assessment

Your task is to analyze her dietary recall and identify any food taboos or myths she reported. Additionally, calculate her estimated total caloric and protein intake from the recall.

Smt. Meena's 24-Hour Dietary Recall:

Time	Food/Drink Consumed	Quantity/Portion Size	Notes/Comments
6:00 am	Warm water with boiled fenugreek seeds	1 glass	Traditional for lactation and digestion
7:30 am	Idli	2 medium size	Easy to digest, energy-rich
10:00 am	Coffee	1 glass (250ml)	Galactogogue
12:30 pm	Cooked rice	1 cup	Gives strength to the body
	Boiled greens (local leafy vegetables)	1/2 cup	Believed to aid recovery
5:00 pm	Coffee	1 glass	Galactogogue
7:00 pm	Bread slice roasted with oil	4 in number	Easy to digest, acts as galactogue
9:00 pm	Warm water	1 glass	Hydration

Food Taboos and Myths Reported:

Avoided Foods:

• Cold foods and drinks: Raw fruits (banana, mango), curd, buttermilk, and cold water are avoided due to belief that they cause “coldness” leading to poor milk supply and infant colic.
• Spicy and oily foods: Onion, garlic, chili, and fried foods are avoided to prevent “heat” in the body and stomach upset.
• Heavy meats: Red meat and fish are generally avoided for 40 days postpartum; only local chicken or freshwater fish might be consumed in some tribes but often avoided by Meena’s family.
• Certain vegetables: Brinjal, cabbage, and gourd are avoided as they are believed to cause gas or interfere with breastmilk quality.
• Leftover food: Only freshly cooked food is consumed, as leftovers are thought to cause weakness and illness.

Beliefs and Practices:

• Ghee and jaggery: Consumed in small amounts to strengthen the body and improve lactation.
• Herbal decoctions: Local herbs such as tulsi (holy basil), ginger, and fenugreek are used to promote recovery and milk production.
• Millets and red rice: Preferred staples believed to provide strength and energy.
• Avoidance of “cold” foods: Concept of “hot” and “cold” foods governs diet; postpartum is considered a “hot” state requiring warm, easily digestible foods.
• Special postpartum dishes: Parboiled rice porridge (kanji) and herbal powders (similar to kalathu powder) are commonly prepared to aid healing.

Based on Smt. Meena's dietary recall and the reported taboos/myths, what are your observations regarding:

1. Common food groups consumed/lacking?
2. Potential nutritional strengths or weaknesses?
3. Specific food taboos/myths that significantly impact her nutrition?

Estimated Caloric and Protein Intake from Smt. Meena's Recall:

Total Calories (kcal):

Total Protein (g):

Appropriate Recommended Daily Intake for Smt. Meena:

Based on her status as a 25-year-old (50 kg) homemaker (sedentary) who is lactating (0-6 months postpartum), determine her recommended daily intake.

Recommended Calories (kcal):

Recommended Protein (g):

AI Dietary Recommendations:

Scenario 4: Assessing Family Dietary Intake & Factors

Time Left: 10:00

You are assessing a family of four: Father (35 years old, clerk, CU=1), Mother (32 years old, homemaker, CU=0.9), Son (10 years old, student, CU=0.8) and Daughter (6 years old, student, CU=0.6).

The concept of Consumption Units (CU) is used to standardize dietary intake across different age and activity groups. **1 CU is equivalent to 2400 Calories and 60 grams of Protein.**

The family purchases the following raw food items for one month, and you are to calculate their daily dietary intake based on the concept of consumption units (CU).

Selected Primary Method: Ecological Assessment & Vital Statistics

Your task is to identify potential nutritional deficiencies or excesses based on their food purchases.

Family Monthly Food Purchases:

Food Item	Total Bought (kg/month)
Milled Rice	18
Wheat flour, atta	9
Red gram	4
Black gram	3
Cow Milk	30 (liters)
Onion	6
Tomato, ripe, local	5
Potato brown small	2
Oil	2 (liters)
Sugar	1.5
Eggs	30
Ground nuts	0.5

Based on this data, identify and explain any potential nutritional deficiencies or excesses you observe in this family's diet.

Scenario 5: Assessing a Suspected Vitamin Deficiency

Time Left: 10:00

A patient presents with specific neurological symptoms, including tingling and numbness in their extremities. They also report difficulty with coordination. Based on their medical history (gastric bypass surgery a few years ago), you highly suspect a specific B vitamin deficiency. You need a definitive diagnosis to initiate targeted treatment.

Selected Primary Method: Biochemical Tests

Given the patient's symptoms and history, your primary suspicion is Vitamin B12 deficiency. Here are the lab results for B vitamins.

Patient's Lab Results for B Vitamins:

Test	Result	Reference Range
Hemoglobin (Hb)	9.8 g/dL	12.0 - 15.5 g/dL
Serum Ferritin	10 ng/mL	20 - 200 ng/mL
Serum Vitamin B12	180 pg/mL	200 - 900 pg/mL
Serum Folate	8 ng/mL	> 3 ng/mL
Serum Albumin	3.9 g/dL	3.5 - 5.0 g/dL
Fasting Blood Glucose	95 mg/dL	70 - 99 mg/dL

1. Do these results confirm your suspicion of Vitamin B12 deficiency? Why or why not? 2. How do the Homocysteine and MMA levels support your conclusion? 3. What would be your immediate nutritional recommendation or next step for this patient based on these findings?

Scenario 6: Tailored Dietary Planning

Time Left: 10:00

A 22-year-old woman, educated up to 10th grade and currently a homemaker, presents with a missed period and a positive urine pregnancy test. She reports no nausea, vomiting, or other symptoms.

**Your Task:** Prepare a tailored balanced dietary plan for 1 day (24hrs) to meet her caloric and protein needs essential for fetal growth and maternal health.

**Reference:** For an adult woman (homemaker, sedentary activity), the baseline caloric requirement is 1900 kcal/day. During pregnancy, an additional 350 kcal/day is needed. The baseline protein requirement is 55g/day. During pregnancy, the recommended protein intake is 75g/day.
**Total Target:** Approximately **2250 Calories** and **75g Protein** per day.

Select food items and quantities for each meal, then calculate the total calories and protein for your plan.

Food Item Choices & Values (Approximate per common serving):

Item	Serving Size	Calories (kcal)	Protein (g)
Idli	2 medium	270	8
Dosa	1 No.	150	4
Poha	1 cup	270	6
Boiled Egg	1 No.	90	6
Cow's Milk	1 cup	180	8
Tea	1 cup	75	1
Rice	1 cup	170	4
Phulka	1 No.	80	2
Plain Dal	1/2 cup	100	7
Chicken Curry	3/4 cup	260	25
Fish Fried	2 big pieces	220	20
Dry Vegetable	1 cup	90	3
Vegetable with gravy	1 cup	150	4
Apple	1 medium	90	0.5
Banana	1 medium	70	1
Groundnuts	50 nos	130	6

Your Daily Diet Plan:

Snack 1 (Before Breakfast):

Item	Quantity	Calories	Protein
Select Item
Select Item

Snack 1 Total: 0 kcal, 0 g

Breakfast:

Item	Quantity	Calories	Protein
Select Item
Select Item
Select Item
Select Item

Breakfast Total: 0 kcal, 0 g

Lunch:

Item	Quantity	Calories	Protein
Select Item
Select Item
Select Item
Select Item

Lunch Total: 0 kcal, 0 g

Snack 2 (After Lunch):

Item	Quantity	Calories	Protein
Select Item
Select Item

Snack 2 Total: 0 kcal, 0 g

Dinner:

Item	Quantity	Calories	Protein
Select Item
Select Item
Select Item
Select Item

Dinner Total: 0 kcal, 0 g

Overall Daily Total: 0 kcal, 0 g

Scenario Completed!

What would you like to do next?

Scenario Feedback

Game Results for

Your total score: 0 points.

Scenario 1: Biochemical Tests Feedback

Your Answer:

Correct Interpretation:

Scenario 2: Anthropometry Feedback

Your Classifications vs. Correct Classifications:

ID	Age (Months)	Sex	Weight (kg)	Height (cm)	Your Wasting/Overweight/Obesity Status	Correct Wasting/Overweight/Obesity Status	Your Stunting Status	Correct Stunting Status	Your Underweight Status	Correct Underweight Status

Scenario 3: Dietary Assessment Feedback

Your Analysis:

Correct Analysis (Key Points):

Your Estimated Intake:

Calories: kcal, Protein: g

Correct Estimated Intake (Target for Lactating Woman):

Calories: kcal, Protein: g

**Assessment:** Smt. Meena's estimated intake is significantly below the recommended daily allowances for a lactating woman. This indicates severe energy and protein deficiency, which can negatively impact her health and breast milk production.

Scenario 4: Ecological Assessment & Vital Statistics Feedback

Your Factors:

Correct Factors (Key Points):

Scenario 5: Biochemical Tests - Specific Deficiency Feedback

Your Answer (Confirmation):

Correct Confirmation:

Your Answer (Homocysteine & MMA):

Correct Explanation (Homocysteine & MMA):

Your Answer (Next Step):

Correct Next Step:

Scenario 6: Tailored Dietary Planning Feedback

Your Planned Totals:

Calories: kcal, Protein: g

Target Totals:

Calories: kcal, Protein: g

**Assessment:** Your plan is evaluated based on how closely your calculated totals match the target requirements for a pregnant woman.