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124 Cards in this Set

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Safrole in nutmeg and Estragole in basil
Carcinogens
Celery, Parsnips, Parsley
Natural Pesticides
Aflatoxin and Botulinum
Toxicants
Vitamin deficiencies are more common in _______
alcoholics
Inadequate intake of protein and calories to meet the bodies need
Protein-energy Malnutrition (PEM)
Aflatoxin causes this cancer
Hepatocellular Cancer
PEM is most common in ________
underdeveloped or developing countries
PEM is associated with _____ diseases
Diarrheal
In developed countries PEM is associated with these 5 things
1. Alcoholism
2. Acute/Chronic Illness
3. Poverty
4. Diet restriction
5. Ignorance
A child with weight < ____% normal is malnourished
80%
2 protein compartments
1. Somatic = skeletal muscles
2. Visceral = mostly liver
Deficiency of total food intake
Marasmus
Deficiency of protein intake
Kwashiorkor
Kwashiorkor can be caused by these 4 things
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
Somatic protein compartment is more severely impacted
Marasmus

*serum albumin normal or slightly reduced
Visceral protein compartment is more severely impacted
Kwashiorkor
Associated symptoms with Kwashiorkor
apathy
listlessness
enlarged fatty liver
Hypoalbuminemia
Hypoalbuminemia causes _____
Anasarca = generalized edema
Kwashiorkor effects on skin and hair
Skin: alternating zones of hyperpigmentation, desquamation

Hair: loss of color or alternating bands of pale and darker hair
Both Marasmus and Kwashiorkor cause these 4 things
1. stunted growth
2. anemia
3. infections and defects in immunity
4. multi-vitamin deficiencies
Pitting edema is characteristic of _________
Kwashiorkor
Secondary PEM is common in ____1____ due to increased __2__
1. chronically ill and hospitalized patients

2. metabolic rate
Cachexia is __1__-like PEM and is usually associated with these __2__
1. Marasmus
2. AIDS, cancer, end-stage lung disease (emphysema)
Secondary PEM that is Kwashiorkor-like is usually seen in these patients (3)
Severe trauma
Burns
Sepsis

*edema, serum albumin < 2.8
Anorexia presents with ______-like findings
PEM
Anorexia causes these 6 things
1. amenorrhea
2. decreased thyroid hormone release
3. decreased bone density
4. anemia
5. lymphopenia
6. Hypoalbuminemia
What is Bulimia
binge eating followed by induced vomiting
Most common cause of death due to Bulimia and Anorexia
Ventricular Arrhythmias caused by Hypokalemia
Bulimia clinical findings (3)
1. Menstrual irregularities
2. Pulmonary aspiration of gastric contents
3. Esophageal and Cardiac rupture
Anorexia: ~1% of __1__
Bulimia: ~4% of __2__
About __3__% with anorexia or bulimia are male
1. adolescent females
2. college-age females
3. 10%
Fat Soluble Vitamins
D
A
K
E
Water-soluble vitamins
B and C
Deficiency in a single vitamin are ________
uncommon
Small amounts of these vitamins can be synthesized endogenously
D
K
Biotin
Niacin
D synthesized by __1__
K and biotin from __2__
Niacin comes from __3__
1. UV light
2. Intestinal microflora
3. tryptophan
causes of Secondary Vitamin Deficiency
disturbances in intestinal absorption, transport in blood, tissue storage, metabolic conversion
Vitamin A has ____-like activity
Hormone
Preformed Vitamin A is found in _______
animals --> liver, fish, eggs, milk, butter
Carotenoids (vitamin A precursor) is found in _____
carrots and leafy green vegetables (spinach)
Vitamin A is essential to the maintenance of ___________
mucus secreting epithelium
*ocular --> lubrication, corneal
Vitamin A ______is a component of the visual pigment _______
Retinal

Rhodopsin
Vitamin A deficiency can cause impaired _______ and also _________
night vision

squamous metaplasia in respiratory and urinary tract
-involved in differentiation of Epithelial cells
Vitamin A deficiency:
Dry eyes = 1
Keratin build up = 2
Corneal softening = 3
1. Xerophthalmia
2. Bitot spots
3. Keratomalacia
Vitamin A is involved in differentiation of ____1____.
Maintains __2___ epithelium and ___3____
1. epithelial cells
2. respiratory
3. urothelium
Vitamin A deficiency predisposes to pulmonary __1__. Keratin debris from squamous metaplasia predisposes to __2__
1. infection
2. renal/bladder stones
Vitamin A enhances ______
immunity
Related Carotenoids are __1__ and __2__
1. photoprotective
2. Antioxidants
Vitamin A deficiency causes a higher mortality rate from _______
measles, pneumonia, diarrhea
Vitamin A acute toxicity symptoms
headache, vomiting, stupor, death
Chronic toxicity symptoms of Vitamin A
weight loss, lip dryness
bone and joint pain
Hepatomegaly with fibrosis
Vitamin A toxicity predisposes to ______
bone fractures due to stimulation of Osteoclasts
Synthetic Retinoids for acne are contraindicated during _______
pregnancy
Retinoids used during pregnancy can cause _______ thru interaction with _______

Symptoms
Retinoic Acid Embryopathy

Homeobox genes (HOX)

CNS, cardiac and craniofacial defects
Excess vitamin A precursors are usually from eating too many ______ or from artificial ________ pills.

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

*not associated with toxicity
Carotenemia = ?
excess vitamin A precursors
Vitamin D maintains plasma levels of _____ and _____
Calcium

Phosphorous
Vitamin D maintains ______ in extracellular compartment
ionized calcium
Vitamin D deficiency results in _______
Poor bone mineralization
-Rickets (if epiphyses have not closed)

-Osteomalacia (epiphyses have closed)
Vitamin D deficiency with low ionized calcium causes ___________
continuous excitation = convulsive state
2 sources of Vitamin D
1. Diet
2. Precursor 7-dehydrocholesterol in the skin and UV light
Most active form of Vitamin D is __1__. It is activated in the __2__ by __3__ and stimulates ___&___ absorption in the gut.
1. 1,25(OH)2
2. kidney
3. alpha-1-hydrolase
4. Ca and Phosphorus
1,25(OH)2 collaborates with _____ in the mobilization of ___ from bone. It stimulates the PTH-dependent reabsorption of calcium in the __________
Parathyroid hormone
Calcium
Distal Renal Tubules
Decreased Vitamin D absorption can cause (4)
Cholestatic Liver Disease
Pancretic Insufficiency
Biliary Tract Obstruction
Extensive small bowel disease
Derangements of Vitamin D metabolism:
-increased degradation by induction of __1___
-impaired synthesis of __2__
-inherited deficiency of __3__
1. cytochrome P450
2. 25 and 1,25(OH)2
3. renal alpha-1 hydrolase
End-organ resistance:
-inherited absence of or defective _____ for 1,25(OH)2
receptors
Phosphate depletion:
-poor phosphate absorption due to ____1___
-excess renal tube excretion of __2__, a condition called __3__
1. aluminum OH antacids
2. phosphate
3. X-linked hypophosphatemic rickets
Vitamin E function
major Antioxidant
Vitamin E sources
vegetables
grains
nuts and their oils
dairy products
meat
fish
Vitamin E deficiency occurs mainly in children that have ________
fat malabsorption (it is a fat-solube vitamin)

*cholecstasis, cystic fibrosis, primary small intestinal disease
Neurologic manifestations of Vitamin E deficiency
absent tendon reflexes
ataxia
dysarthria
loss of vibration sense
pain sensation

Spinocerebellar Degeneration
Vitamin K functions
functional activity of Factors 2, 7, 9, 10 and Protein C and S

*Koagulation
Studies suggest Vitamin K may be helpful in treating ______
Osteoporosis

*may favor calcification of bone proteins
Vitamin K deficiency due to:
-___1____ syndromes
-___2___ disease
1. fat malabsorption
2. diffuse liver
2 instances for the absence of Vitamin K-synthesizing bacterial flora
1. broad spectrum antibiotics
2. not fully developed neonates
Vitamin K deficiency has a tendency for ___1____, deficiency is induced by __2___ which is used for ____3____ disease
1. bleeding
2. coumarin (warfarin)
3. thromboembolic
B1 = 1
B2 = 2
B3 = 3
B5 = 4
B6 = 5
B7 = 6
B12 = 7
1. Thiamine
2. Riboflavin
3. Niacin
4. Pantothenic Acid
5. Pyridoxine
6. Biotin
7. Cobalamin
All B vitamins function as _____ and needs are tied to _________
coenzymes
energy intake
Thiamine Deficiency occurs in developing countries where _____ is most of the diet
polished rice
3 Major targets of Thiamine deficiency
1. nerves
2. heart
3. brain
3 disease of Thiamine deficiency
1. Dry Beriberi (polyneuropathy)
2. Wet Beriberi (CV)
3. Wernicke-Korsakoff Syndrome
Beriberi is common in __1__
Also common in:
-__2__ of pregnancy
-__3__ that impair appetite
-extended __4__ therapy without supplemental vitamins
1. alcoholics
2. pernicious vomiting
3. delibitating diseases
4. IV glucose
What is Dry Beriberi?
Peripheral Neuropathy with resultant atrophy of muscles of extremeties
What is Wet beriberi?
-results from peripheral dilation of arterioles and capillaries
-congestive Cardiomyopathy with Biventricular failure
Wernicke-Korsakoff syndrome results from hemorrhage of _________
Mammilary bodies
Sources of Riboflavin (B2)

It absorbed in the ______
Meat
Dairy
Vegetables

Upper GI tract
Ariboflavinosis is caused by _________
severe malnourishment
-alcoholics
-chronic infections
-advanced cancer
-individuals who avoid milk
4 Symptoms of Riboflavin deficiency
1. Cheliosis = cracks at angles of mouth
2. Glossitis (atrophic tongue)
3. Corneal opacities
4. Dermatitis
Sources of Niacin
Grains
Legumes
Seed oils
Niacin can be synthesized endogenously from _____
Tryptophan

*deficiency of Tryptophan can mimic niacin deficiency
Niacin deficiency causes ______, which is characterized by _______
Pellagra

the 3 D's
-dementia
-dermatitis
-diarrhea
Pyridoxine deficiency resemble ______
B2 and B3 deficiencies

*deficiency is rare
Drug that can cause Pyridoxine deficiency
Isoniazide

*competitive inhibitors for pyridoxine binding sites
Vitamin C function
formation of normal Collagen
-hydroxlation of Lysine and Proline residues
Disease caused by Vitamin C deficiency
Scurvy
At risk people for Scurvy
1. elderly who live alone
2. alcoholics
3. infants fed only processed milk
Symptoms of Vitamin C are reversible almost ________
immediately
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__
1. wound healing
2. ecchymoses and purpura
3. gum
4. hematomas
5. hemarthrosis
6. intracerebral
7. osteoid matrix
Vitamin C deficiency in children causes
bowing of long bones and depression of the sternum with outward projection of the ends of the ribs
Vitamin C: poor __1__

Vitamin D: poor __2__
1. osteoid production

2. mineralization (calcification of bone)
Difference in Vitamin C and D sternum symptoms
C: depression of sternum with outward projection of ribs

D: protrusion of sternum with overgrowth of cartilage at costochondral jxn = rachitic rosary
Folate is depleted in _____ foods
cooked and processed
Folate requirement is increased during ________.

Deficiency can predispose to ________
pregnancy

fetal neural tube defects
Folate and ___1___ are essential for nucleic acid synthesis
- a deficiency of either will result in ___2___
Vitamin B12 (Cobalamin)

Megaloblastic anemia
Combined Folate and Vitamin B12 deficiency may contribute to development of ________
colon cancer
Vitamin B12 deficiency causes ______
Sub-acute combined degeneration of the spinal cord
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
1. reversible
2. numbness
3. spastic weakness
4. paraplegia
5. ascending
6. descending
Minerals whose deficiencies can cause symptoms (5)
Iron
Zinc
Copper
Selenium
Iodine

*SCIZI
Mineral deficiency most common in US
Iron
Iron deficiency:
-in kids, usually due to __1_
-in adults, due to __2__
-__3__ anemia
1. inadequate intake
2. blood loss or pregnancy
3. hypochromic microcytic = defective heme synthesis
Zinc deficiency is usually due to __1__ or __2__
1. TPN unsupplemented by zinc

2. congenital zinc deficiency (autosomal recessive)
2 findings in Zinc Deficiency
1. Acrodermatitis Enteropathica = rash around eyes, nose, mouth, and anus

2. Anorexia, diarrhea, growth retardation, imppaired night vision
Selenium fxn
Antioxidant

*like E and C
Selenium deficiency is known as ___1___ disease
- results from low level in __2__
- causes __3__
Keshan Disease
soil, water, food
Congestive Cardiomyopathy
__% of adults in the US are obese
30%
BMI in obese is greater than or equal to ____
30
3 things that begin to increase at BMI value >25
Hypertension
Diabetes
Coronary Artery Disease
Type of Obesity that has a higher risk for disease
Central/Visceral
Metabolic Syndrome is characterized by these things
Abdominal obesity
Insulin resistance
Hypertriglyceridemia
low HDL
Hypertension
CAD
Adipocytes secrete ____ to communicate with the Hypothalamus
Leptin
Net effect of Leptin
decrease food intake

increase energy expenditure
Leptin levels are _____ in most obese individuals
increased
Rarely, obesity occurs from _______
single gene defects in leptin-melanocortin pathway
Hormone that increases appetite
Ghrelin

secreted from stomach
When is Leptin increased?
when adipose stores are adequate