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82 Cards in this Set

  • Front
  • Back
Name the two essential fatty acids.
- linoleic acid
- arachidonic acid
Name the fat soluble vitamins.
A, D, E, K
Name the water soluble vitamins.
B, C
Name the macrominerals.
Ca, P, Fe, I
Name the microminerals.
Zn, Se, Cu
What is the major cause of malnutrition in the U.S., primary or secondary?
secondary
- decreased intake
- malabsorption
- increased requirement
Early or late stage malnutrition?

- morphologic change
late
Early or late stage malnutrition?

- functional change
early
Malnutrition of which protein compartment?

- marasmus
somatic
- actin
- myocin
Malnutrition of which protein compartment?

- kwashiorkor
visceral
- proteins made by the liver: eg albumin
Marasmus or kwashiorhor?

- growth retardation
- muscle wasting
- loss of subcutaneous fat
- pinched facies, premature aging
- alert
- hungery acting
marasmus
- overall lack of protein -> starvation
- somatic protein loss: actin, myocin
Marasmus or kwashiorhor?

- generalized edema: moon facies, pot belly
- zones of hyper- and hypo- pigmented skin
- hair with "flag" sign
- apathy
- hepatomegaly
Kwashiorkor
- overall lack of protein
- caloric intake may be sufficient
- disease of the displaced child
Starvation:
What is the first fuel used?
glycogen
- reserves are small
- stored in liver and muscle
Starvation:
What is the fuel being used?

- ketone bodies appear in urine
- increased urinary nitrogen excretion
fat and protein
- large reserves
- utilization starts as glycogen is depleted
Starvation:
What is the body doing?

- digestive enzyme synthesis stops
- liver synthesis of carrier protein stops
- muscle proteins are not made
protein synthesis stops to conserve energy for brain (it has not acquired the ability to use ketone bodies yet).
After long standaing starvation, protein synthesis stops. What is the body's respond after that?
brain acquires ability to use ketone bodies as energy source
- protein catabolism resumed
Why do people with kwashiorkor have big liver?
Liver is not making lipoprotein to excrete fat synthesized in hepatocytes -> fatty liver
What is the most striking abnormaluty of Kwashiorkor in clinical lab?
hypoalbuminemia
- albumin level < 2.8 gm/dl
What are some clinical problems in protein/energy malnutrition?
- depressed immune response: worsen/recurrent infection
- anemia
Which has more body store, fat soluble or water soluble vitamines?
fat-soluble vitamines
What is the transport form of vit A?
retinol (alcohol)
What is the storage form of vit A?
retinyl (ester)
What is the vision form of vit A?
retinal (aldehyde)
What is the form of vit A that aid in epithelial differentiation and growth, and is directly absorbed?
retinoic acid (carboxylic acid)
What is the form of vit A found in plant?
carotene (provitamin A)
What is this form of vit A?

- a linked vitamin A
beta-carotene
What is this form of vit A?

- natually occuring and synthetic analogues
- not functionally active
retinoids
How long does the liver store vit A as ester for?
6 months
Functions of vit A.
- maintain mucosal epithelial differentiation: prevent dryness, anti-cancer
- provide visual pigment (rhodopsin)
- enhance immunity
- anti-oxidant
How does Vit A deficiency cause the following?

- xerophthalmia
- xerosis
squamous metaplasia -> block hydration, also present in the following areas:

- respiratory epithelium
- GU epithelium
- salivary glands, pancreas, sebaceous glands
What is the effect of Vit A deficiency on GI epithelium?
decreased goblet cells
Which vitamin deficiency is this?

- xerophthlamia
- xerosis
- bitot spots, ulcers
- keratomalacia (corneal softening)
- impaired night vision
vitamin A deficiency
11-cis-retinal or trans-retinal?

- converts to rhodopsin
11-cis-retinal
Which vitamine can be used to treat AML, M3 subtype (APL)?
Vitamin A
- differentiate hematopoietic white blood cells in bone marrow
An infant presents with vomiting, stupor, papilledema, loss of hair, peeling of skin, large liver, which vitamin toxicity is this?
acute Vit A toxicity
- more common in infants
- premature closure of fonanelles -> increased intracranial pressure -> headache, vomiting, stupor, papilledema.
What is this vitamine toxicity?

- adult presents with wt loss, skin peeling, mucosal dryness, bone and joint pain, headaches, dizziness, blurred vision.
chronic vit A toxicity
- more common in adults
T/F: 80% of VitD need comes from endogenous synthesis in the skin.
T.
Skin makes 7-dehydrocholesterol, need uv light to D3 (cholecalciferol)
Link the following in the sequence of Vit D synthesis and metabolism.

- cholecalciferol (D3)
- 7-dehydrocholerol
- 25-OH-D3
- 1,25-OH2-D3
7-dehydrocholerol (skin) + uv light -> cholecalciferol (D3) + liver -> 25-OH-D3 + kidney (1-a-hydroxylase) -> 1,25-OH2-D3
Which form of vit D is this?

- dietary form in plants
ergocalciferol (D2)
Functions of vit D.
- maintain serum Ca and P level for bone mineralization
- prevents hypocalcemic tetany
T/F: Vit D is needed in both bone remodeling and epiphyseal plate mineralization.
T.
- deficiency in adult cause osteomalasia
- deficiency in kids cause rickets
General categories of causes of vit D deficiency.
- diffuse liver disease: decreased DBP synthesis
- chronic renal failure: lack of 1-a-hydroxylase
- nephrotic syndrome: increased excretion of DBP
- drugs: P450 inducers (phenytoin, phenobarbital, rafampin)
Mechanism of vit-D dependent rickets type I.
- defective 1-a-hydroxylase
Mechanism of vit-D dependent rickets type II.
defective vitD receptor
What type of ricket is this?

- hypophosphatemia
- normocalcemia
- low to normal calcitriol
X-linked hypophosphatemic rickets
- renal phosphate wasting and impaired intestinal ca absorption
Mechanism of tumor induced rickets/osteomalasia.
secretion of PTHRP (osteolytic)
Which vitamine deficiency is this?

- rachitic rosary (beading of ribs)
- pigeon-breast deformity
- craniotabes (soft bone)
- frontal bossing
- lumbar lordosis
- bowing of legs
vit D deficiency
Excess vitD may cause what conditions?
- hypercalcemia
- metastatic calcification
- renal stones
What is this vitamin?

- anti-oxidant: protect polyunsaturated fatty acids from free radical peroxidation
- transported unchanged in blood
- no need for carrier protein
Vit E
- 4 tocopherols
- 4 tocotrienols
- alpha-tocopherol is the most potent
Name some causes of vitE deficiency.
- abetalipoproteinemia: apoB needed for vitE transport
- cholestasis
- cystic fibrosis (pancreas)
- malabsorption
- low birth weight in neonates
What is this vitamin deficiency?

- spinocerebellar degeneration
- skeletal muscle denevation injury
- hemolytic anemia
- pigmented retinopathy
Vit E deficiency
- nerve membrane, red cell membrane susceptible to decreased vitE (loss of protection against free radical peroxidation)
What is this vitamin deficiency?

- depressed tendon reflex
- ataxia
- dysarthria
- loss of pain, positional sense
- impaired vision
- eye movement disorder
- muscle weakness
Vit E deficiency
- nerve membrane, red cell membrane susceptible to decreased vitE (loss of protection against free radical peroxidation)
Vit K participated in activation of what coagulation factors, others?
factors II, VII, IX, X
protein C and S
osteocalcin

* cofactor in carboxylase reactions
How does warfarin work as anticoagulant?
block reduction from vitK epoxide to vitK -> less coagulation factors produced
T/F: Primary vitK deficiency is more common in adults than secondary deficiency.
F
What are some causes of seconary vit K deficiency in adults?
- malabsorption
- antiobiotics
- liver disease
- anticoagulation therapy
What are some primary causes of vit K deficiency in infants?
- little transplacental transport
- sterile gut
- breast milk low in vit K
What is the functionally active coenzyme form of B1 (thiamine)?
thiamine pyrophosphate (TPP)
- oxidative phosphorylation of keto acids
- cofactor for transketolase of pentose phosphate shunt (PPS)
- maintain neural membranes and normal nerve conductions
What conditions can be caused by thiamine (B1) deficiency?
- dry Beriberi: peripheral neuropathy
- wet Beriberi: myocardial damage
- wernicke-Korsakoff syndrome
What is this vitamin deficiency?

- bilateral foot drop
- wrist drop next
- diet lack whole grain, legumes
-
This is dry beriberi due to thiamine deficiency
- myelin degeneration
What is this vitamin deficiency?

- cardiomegaly
- pale and flabby myocardium
- output heart failure
- diet of polished rice
This is wet beriberi due to thiamine deficiency
- peripheral vasodilation (rapid AV shunting)
What is this vitamin deficiency?

- ophthalmoplegia
- nystagmus
- ataxia
- deranged mental function
- chronic alcohol consumption
wernicke's encephalopathy
- lateral rectus muscle (CN6) often affected
What is this vitamin deficiency?

- retrograde amnesia
- inability to acquire new information
- confabulation
- chronic alcohol intake
koesakoff's psychosis caused by thiamine deficiency
What anatomical lesion would you see in werneke-koesakoff lesion due to thiamine deficiency?
- hemorrhage in mamillary bodies
- hemorrhage in periventricular region of the thalamus
- degeneration in the anterior cerebellar vermis
What is this vitamin deficiency?

- polyneuropathy: numb, tingling feet, decreased reflexes, foot and wrist drop
- muscle wasting
- congestive heart failure
- ataxia
- 6th cranial nerve ophthalmoplegia
Beriberi due to thiamine deficiency
How to treat Beriberi?
Give thiamine before IV glucose
Which vitamine is this?

- cofactor in FAD reactions
- cofactor at succinate dehydrogenase step of kreb's cycle
riboflavin (B2)
What is this vitamine deficiency?

- angular cheilitis
- glossitis
- stomatitis
- corneal vascularization, inflammation, scarring
- dematitis (greasy scales)
riboflavin deficiency (B2)
- cofactor in FAD reactions
- cofactor for succinate dehydrogenase step in kreb cycle
- actively transported
What is this vitamine?

- NAD and NADP reactions
- synthesized from tryptophan
- tighly bound in maize
niacin (B3)
- deficiency cause pollegra
What is this vitamine deficiency?

- rough skin
- diarrhea
- dementia
- fatigue, weakness
niacin (B3) deficiency (pollegra)
- dermatitis in sun exposed area
- atrophic GI mucosa: diarrhea
- dementia: neuronal degeneration
Who are at risk at developing pollegra (B3 deficiency)?
- maize rich diet
- drugs: isoniazid, 6-MP
- carcinoid tumor
- harnup's disease (trp malabsorption)
What is this vitamin?

- involved in heme precursor synthesis
- involved in GABA synthesis
pyridoxine (B6)
- coenzyme is pyridoxal-5-phosphate
- deficiency cause seborreic dermatitis, cheilosis, stomatitis, peripheral neuropathy, convulsions, imparied T cell synthesis, impaired antibody synthesis, hypochromic anemia
What is this vitamine deficiency?

- seborreic dermatitis
- peripheral neuropathy
- convulsions
- impaired T cell function and antibody synthesis
- hypochromic anemia
- alcoholic consumption, estrogen, penicilllamine, isoniazid
pyridoxine (B6)
- heme synthesis
- GABA synthesis
What can cause pyridoxine deficiency?
- alcoholic consumption
- estrogen
- penicilllamine
- isoniazid
What is this vitamin?

- activation of prolyl and lysyl hydroxylase which accelerates hydroxylation of procollagen
- regenerates vit E
vit C
- absorbed by active transport
- deficiency causes scurvy
What is this vitamin deficiency?

- bleeding into joints, gums, brain
- decreased osteoid production
- impaired wound healing
- anemia
- occurs in infant
infantile scurvy (vitC deficiency)
- impaired collagen synthesis
What is this vitamin deficiency?

- skin purpura
- easily bruised
- bleeding gums
- occur in adults
adult scurvy (vitC) deficiency
- impaired collagen synthesis
What is the risk of taking megadoses of vitC?
- uricosuria
- iron overload
- acidosis with background renal disease
- hemolysis in G-6-PD deficiency
What is this vitamine?

- most important in purine synthesis: 1-C transfer
- destroyed by cooking
- deficiency leads to impaired cell division
folic acid (B9)
- tetrafolate
- absorbed in jejunum
What is the vitamin deficiency?

- megaloblastic anemia
- anemia corrected by folate, but neurologic problem persist
B12 deficiency
What is this nutritional deficiency?

- hemorrhagic dermatitis
- acrodermatitis enteripathica
- anorexia, diarrhea
- growth retardation
- hypogonadism
- depressed wound healing
- impaired immunity
zinc
What is this mineral?

- component of glutathione peroxidase
- antioxidant
- deficiency cause congestive cardiomyopathy in china
selenium