05 - Nutritional Pathology

Front 1

Safrole in nutmeg and Estragole in basil

Back 1

Carcinogens

Front 2

Celery, Parsnips, Parsley

Back 2

Natural Pesticides

Front 3

Aflatoxin and Botulinum

Back 3

Toxicants

Front 4

Vitamin deficiencies are more common in _______

Back 4

alcoholics

Front 5

Inadequate intake of protein and calories to meet the bodies need

Back 5

Protein-energy Malnutrition (PEM)

Front 6

Aflatoxin causes this cancer

Back 6

Hepatocellular Cancer

Front 7

PEM is most common in ________

Back 7

underdeveloped or developing countries

Front 8

PEM is associated with _____ diseases

Back 8

Diarrheal

Front 9

In developed countries PEM is associated with these 5 things

Back 9

1. Alcoholism
2. Acute/Chronic Illness
3. Poverty
4. Diet restriction
5. Ignorance

Front 10

A child with weight < ____% normal is malnourished

Back 10

80%

Front 11

2 protein compartments

Back 11

1. Somatic = skeletal muscles
2. Visceral = mostly liver

Front 12

Deficiency of total food intake

Back 12

Marasmus

Front 13

Deficiency of protein intake

Back 13

Kwashiorkor

Front 14

Kwashiorkor can be caused by these 4 things

Back 14

1. babies weaned early and put on carb diet (MOST COMMON)
2. chronic diarrhea (protein not absorbed)
3. protein losing enteropathies
4. Nephrotic syndrome = lose albumin

Front 15

Somatic protein compartment is more severely impacted

Back 15

Marasmus

*serum albumin normal or slightly reduced

Front 16

Visceral protein compartment is more severely impacted

Back 16

Kwashiorkor

Front 17

Associated symptoms with Kwashiorkor

Back 17

apathy
listlessness
enlarged fatty liver
Hypoalbuminemia

Front 18

Hypoalbuminemia causes _____

Back 18

Anasarca = generalized edema

Front 19

Kwashiorkor effects on skin and hair

Back 19

Skin: alternating zones of hyperpigmentation, desquamation

Hair: loss of color or alternating bands of pale and darker hair

Front 20

Both Marasmus and Kwashiorkor cause these 4 things

Back 20

1. stunted growth
2. anemia
3. infections and defects in immunity
4. multi-vitamin deficiencies

Front 21

Pitting edema is characteristic of _________

Back 21

Kwashiorkor

Front 22

Secondary PEM is common in ____1____ due to increased __2__

Back 22

1. chronically ill and hospitalized patients

2. metabolic rate

Front 23

Cachexia is __1__-like PEM and is usually associated with these __2__

Back 23

1. Marasmus
2. AIDS, cancer, end-stage lung disease (emphysema)

Front 24

Secondary PEM that is Kwashiorkor-like is usually seen in these patients (3)

Back 24

Severe trauma
Burns
Sepsis

*edema, serum albumin < 2.8

Front 25

Anorexia presents with ______-like findings

Back 25

PEM

Front 26

Anorexia causes these 6 things

Back 26

1. amenorrhea
2. decreased thyroid hormone release
3. decreased bone density
4. anemia
5. lymphopenia
6. Hypoalbuminemia

Front 27

What is Bulimia

Back 27

binge eating followed by induced vomiting

Front 28

Most common cause of death due to Bulimia and Anorexia

Back 28

Ventricular Arrhythmias caused by Hypokalemia

Front 29

Bulimia clinical findings (3)

Back 29

1. Menstrual irregularities
2. Pulmonary aspiration of gastric contents
3. Esophageal and Cardiac rupture

Front 30

Anorexia: ~1% of __1__
Bulimia: ~4% of __2__
About __3__% with anorexia or bulimia are male

Back 30

1. adolescent females
2. college-age females
3. 10%

Front 31

Fat Soluble Vitamins

Back 31

D
A
K
E

Front 32

Water-soluble vitamins

Back 32

B and C

Front 33

Deficiency in a single vitamin are ________

Back 33

uncommon

Front 34

Small amounts of these vitamins can be synthesized endogenously

Back 34

D
K
Biotin
Niacin

Front 35

D synthesized by __1__
K and biotin from __2__
Niacin comes from __3__

Back 35

1. UV light
2. Intestinal microflora
3. tryptophan

Front 36

causes of Secondary Vitamin Deficiency

Back 36

disturbances in intestinal absorption, transport in blood, tissue storage, metabolic conversion

Front 37

Vitamin A has ____-like activity

Back 37

Hormone

Front 38

Preformed Vitamin A is found in _______

Back 38

animals --> liver, fish, eggs, milk, butter

Front 39

Carotenoids (vitamin A precursor) is found in _____

Back 39

carrots and leafy green vegetables (spinach)

Front 40

Vitamin A is essential to the maintenance of ___________

Back 40

mucus secreting epithelium
*ocular --> lubrication, corneal

Front 41

Vitamin A ______is a component of the visual pigment _______

Back 41

Retinal

Rhodopsin

Front 42

Vitamin A deficiency can cause impaired _______ and also _________

Back 42

night vision

squamous metaplasia in respiratory and urinary tract
-involved in differentiation of Epithelial cells

Front 43

Vitamin A deficiency:
Dry eyes = 1
Keratin build up = 2
Corneal softening = 3

Back 43

1. Xerophthalmia
2. Bitot spots
3. Keratomalacia

Front 44

Vitamin A is involved in differentiation of ____1____.
Maintains __2___ epithelium and ___3____

Back 44

1. epithelial cells
2. respiratory
3. urothelium

Front 45

Vitamin A deficiency predisposes to pulmonary __1__. Keratin debris from squamous metaplasia predisposes to __2__

Back 45

1. infection
2. renal/bladder stones

Front 46

Vitamin A enhances ______

Back 46

immunity

Front 47

Related Carotenoids are __1__ and __2__

Back 47

1. photoprotective
2. Antioxidants

Front 48

Vitamin A deficiency causes a higher mortality rate from _______

Back 48

measles, pneumonia, diarrhea

Front 49

Vitamin A acute toxicity symptoms

Back 49

headache, vomiting, stupor, death

Front 50

Chronic toxicity symptoms of Vitamin A

Back 50

weight loss, lip dryness
bone and joint pain
Hepatomegaly with fibrosis

Front 51

Vitamin A toxicity predisposes to ______

Back 51

bone fractures due to stimulation of Osteoclasts

Front 52

Synthetic Retinoids for acne are contraindicated during _______

Back 52

pregnancy

Front 53

Retinoids used during pregnancy can cause _______ thru interaction with _______

Symptoms

Back 53

Retinoic Acid Embryopathy

Homeobox genes (HOX)

CNS, cardiac and craniofacial defects

Front 54

Excess vitamin A precursors are usually from eating too many ______ or from artificial ________ pills.

Symptoms

Back 54

1. carrots
2. suntanning
3. Yellow skin but Sclera remain white

*not associated with toxicity

Front 55

Carotenemia = ?

Back 55

excess vitamin A precursors

Front 56

Vitamin D maintains plasma levels of _____ and _____

Back 56

Calcium

Phosphorous

Front 57

Vitamin D maintains ______ in extracellular compartment

Back 57

ionized calcium

Front 58

Vitamin D deficiency results in _______

Back 58

Poor bone mineralization
-Rickets (if epiphyses have not closed)

-Osteomalacia (epiphyses have closed)

Front 59

Vitamin D deficiency with low ionized calcium causes ___________

Back 59

continuous excitation = convulsive state

Front 60

2 sources of Vitamin D

Back 60

1. Diet
2. Precursor 7-dehydrocholesterol in the skin and UV light

Front 61

Most active form of Vitamin D is __1__. It is activated in the __2__ by __3__ and stimulates ___&___ absorption in the gut.

Back 61

1. 1,25(OH)2
2. kidney
3. alpha-1-hydrolase
4. Ca and Phosphorus

Front 62

1,25(OH)2 collaborates with _____ in the mobilization of ___ from bone. It stimulates the PTH-dependent reabsorption of calcium in the __________

Back 62

Parathyroid hormone
Calcium
Distal Renal Tubules

Front 63

Decreased Vitamin D absorption can cause (4)

Back 63

Cholestatic Liver Disease
Pancretic Insufficiency
Biliary Tract Obstruction
Extensive small bowel disease

Front 64

Derangements of Vitamin D metabolism:
-increased degradation by induction of __1___
-impaired synthesis of __2__
-inherited deficiency of __3__

Back 64

1. cytochrome P450
2. 25 and 1,25(OH)2
3. renal alpha-1 hydrolase

Front 65

End-organ resistance:
-inherited absence of or defective _____ for 1,25(OH)2

Back 65

receptors

Front 66

Phosphate depletion:
-poor phosphate absorption due to ____1___
-excess renal tube excretion of __2__, a condition called __3__

Back 66

1. aluminum OH antacids
2. phosphate
3. X-linked hypophosphatemic rickets

Front 67

Vitamin E function

Back 67

major Antioxidant

Front 68

Vitamin E sources

Back 68

vegetables
grains
nuts and their oils
dairy products
meat
fish

Front 69

Vitamin E deficiency occurs mainly in children that have ________

Back 69

fat malabsorption (it is a fat-solube vitamin)

*cholecstasis, cystic fibrosis, primary small intestinal disease

Front 70

Neurologic manifestations of Vitamin E deficiency

Back 70

absent tendon reflexes
ataxia
dysarthria
loss of vibration sense
pain sensation

Spinocerebellar Degeneration

Front 71

Vitamin K functions

Back 71

functional activity of Factors 2, 7, 9, 10 and Protein C and S

*Koagulation

Front 72

Studies suggest Vitamin K may be helpful in treating ______

Back 72

Osteoporosis

*may favor calcification of bone proteins

Front 73

Vitamin K deficiency due to:
-___1____ syndromes
-___2___ disease

Back 73

1. fat malabsorption
2. diffuse liver

Front 74

2 instances for the absence of Vitamin K-synthesizing bacterial flora

Back 74

1. broad spectrum antibiotics
2. not fully developed neonates

Front 75

Vitamin K deficiency has a tendency for ___1____, deficiency is induced by __2___ which is used for ____3____ disease

Back 75

1. bleeding
2. coumarin (warfarin)
3. thromboembolic

Front 76

B1 = 1
B2 = 2
B3 = 3
B5 = 4
B6 = 5
B7 = 6
B12 = 7

Back 76

1. Thiamine
2. Riboflavin
3. Niacin
4. Pantothenic Acid
5. Pyridoxine
6. Biotin
7. Cobalamin

Front 77

All B vitamins function as _____ and needs are tied to _________

Back 77

coenzymes
energy intake

Front 78

Thiamine Deficiency occurs in developing countries where _____ is most of the diet

Back 78

polished rice

Front 79

3 Major targets of Thiamine deficiency

Back 79

1. nerves
2. heart
3. brain

Front 80

3 disease of Thiamine deficiency

Back 80

1. Dry Beriberi (polyneuropathy)
2. Wet Beriberi (CV)
3. Wernicke-Korsakoff Syndrome

Front 81

Beriberi is common in __1__
Also common in:
-__2__ of pregnancy
-__3__ that impair appetite
-extended __4__ therapy without supplemental vitamins

Back 81

1. alcoholics
2. pernicious vomiting
3. delibitating diseases
4. IV glucose

Front 82

What is Dry Beriberi?

Back 82

Peripheral Neuropathy with resultant atrophy of muscles of extremeties

Front 83

What is Wet beriberi?

Back 83

-results from peripheral dilation of arterioles and capillaries
-congestive Cardiomyopathy with Biventricular failure

Front 84

Wernicke-Korsakoff syndrome results from hemorrhage of _________

Back 84

Mammilary bodies

Front 85

Sources of Riboflavin (B2)

It absorbed in the ______

Back 85

Meat
Dairy
Vegetables

Upper GI tract

Front 86

Ariboflavinosis is caused by _________

Back 86

severe malnourishment
-alcoholics
-chronic infections
-advanced cancer
-individuals who avoid milk

Front 87

4 Symptoms of Riboflavin deficiency

Back 87

1. Cheliosis = cracks at angles of mouth
2. Glossitis (atrophic tongue)
3. Corneal opacities
4. Dermatitis

Front 88

Sources of Niacin

Back 88

Grains
Legumes
Seed oils

Front 89

Niacin can be synthesized endogenously from _____

Back 89

Tryptophan

*deficiency of Tryptophan can mimic niacin deficiency

Front 90

Niacin deficiency causes ______, which is characterized by _______

Back 90

Pellagra

the 3 D's
-dementia
-dermatitis
-diarrhea

Front 91

Pyridoxine deficiency resemble ______

Back 91

B2 and B3 deficiencies

*deficiency is rare

Front 92

Drug that can cause Pyridoxine deficiency

Back 92

Isoniazide

*competitive inhibitors for pyridoxine binding sites

Front 93

Vitamin C function

Back 93

formation of normal Collagen
-hydroxlation of Lysine and Proline residues

Front 94

Disease caused by Vitamin C deficiency

Back 94

Scurvy

Front 95

At risk people for Scurvy

Back 95

1. elderly who live alone
2. alcoholics
3. infants fed only processed milk

Front 96

Symptoms of Vitamin C are reversible almost ________

Back 96

immediately

Front 97

Scurvy:
- poor ___1__
- __2__ in the skin and gingival mucosa
- secondary __3__ infections
- subperiosteal __4__ and __5__ after minimal trauma
- __6__ hemorrhages that can be fatal
- Skeletal changes due to insufficient __7__

Back 97

1. wound healing
2. ecchymoses and purpura
3. gum
4. hematomas
5. hemarthrosis
6. intracerebral
7. osteoid matrix

Front 98

Vitamin C deficiency in children causes

Back 98

bowing of long bones and depression of the sternum with outward projection of the ends of the ribs

Front 99

Vitamin C: poor __1__

Vitamin D: poor __2__

Back 99

1. osteoid production

2. mineralization (calcification of bone)

Front 100

Difference in Vitamin C and D sternum symptoms

Back 100

C: depression of sternum with outward projection of ribs

D: protrusion of sternum with overgrowth of cartilage at costochondral jxn = rachitic rosary

Front 101

Folate is depleted in _____ foods

Back 101

cooked and processed

Front 102

Folate requirement is increased during ________.

Deficiency can predispose to ________

Back 102

pregnancy

fetal neural tube defects

Front 103

Folate and ___1___ are essential for nucleic acid synthesis
- a deficiency of either will result in ___2___

Back 103

Vitamin B12 (Cobalamin)

Megaloblastic anemia

Front 104

Combined Folate and Vitamin B12 deficiency may contribute to development of ________

Back 104

colon cancer

Front 105

Vitamin B12 deficiency causes ______

Back 105

Sub-acute combined degeneration of the spinal cord

Front 106

Sub-acute Combined Degeneration of teh spinal cord:
-potentially __1__
-__2__ in the lower extremities progressing to __3__ and then __4__
Degeneration of both __5_ and __6__ tracts of spinal cord

Back 106

1. reversible
2. numbness
3. spastic weakness
4. paraplegia
5. ascending
6. descending

Front 107

Minerals whose deficiencies can cause symptoms (5)

Back 107

Iron
Zinc
Copper
Selenium
Iodine

*SCIZI

Front 108

Mineral deficiency most common in US

Back 108

Iron

Front 109

Iron deficiency:
-in kids, usually due to __1_
-in adults, due to __2__
-__3__ anemia

Back 109

1. inadequate intake
2. blood loss or pregnancy
3. hypochromic microcytic = defective heme synthesis

Front 110

Zinc deficiency is usually due to __1__ or __2__

Back 110

1. TPN unsupplemented by zinc

2. congenital zinc deficiency (autosomal recessive)

Front 111

2 findings in Zinc Deficiency

Back 111

1. Acrodermatitis Enteropathica = rash around eyes, nose, mouth, and anus

2. Anorexia, diarrhea, growth retardation, imppaired night vision

Front 112

Selenium fxn

Back 112

Antioxidant

*like E and C

Front 113

Selenium deficiency is known as ___1___ disease
- results from low level in __2__
- causes __3__

Back 113

Keshan Disease
soil, water, food
Congestive Cardiomyopathy

Front 114

__% of adults in the US are obese

Back 114

30%

Front 115

BMI in obese is greater than or equal to ____

Back 115

30

Front 116

3 things that begin to increase at BMI value >25

Back 116

Hypertension
Diabetes
Coronary Artery Disease

Front 117

Type of Obesity that has a higher risk for disease

Back 117

Central/Visceral

Front 118

Metabolic Syndrome is characterized by these things

Back 118

Abdominal obesity
Insulin resistance
Hypertriglyceridemia
low HDL
Hypertension
CAD

Front 119

Adipocytes secrete ____ to communicate with the Hypothalamus

Back 119

Leptin

Front 120

Net effect of Leptin

Back 120

decrease food intake

increase energy expenditure

Front 121

Leptin levels are _____ in most obese individuals

Back 121

increased

Front 122

Rarely, obesity occurs from _______

Back 122

single gene defects in leptin-melanocortin pathway

Front 123

Hormone that increases appetite

Back 123

Ghrelin

secreted from stomach

Front 124

When is Leptin increased?

Back 124

when adipose stores are adequate