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82 Cards in this Set
- Front
- Back
Name the two essential fatty acids.
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- linoleic acid
- arachidonic acid |
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Name the fat soluble vitamins.
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A, D, E, K
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Name the water soluble vitamins.
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B, C
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Name the macrominerals.
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Ca, P, Fe, I
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Name the microminerals.
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Zn, Se, Cu
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What is the major cause of malnutrition in the U.S., primary or secondary?
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secondary
- decreased intake - malabsorption - increased requirement |
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Early or late stage malnutrition?
- morphologic change |
late
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Early or late stage malnutrition?
- functional change |
early
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Malnutrition of which protein compartment?
- marasmus |
somatic
- actin - myocin |
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Malnutrition of which protein compartment?
- kwashiorkor |
visceral
- proteins made by the liver: eg albumin |
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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 |
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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 |
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Starvation:
What is the first fuel used? |
glycogen
- reserves are small - stored in liver and muscle |
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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 |
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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).
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After long standaing starvation, protein synthesis stops. What is the body's respond after that?
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brain acquires ability to use ketone bodies as energy source
- protein catabolism resumed |
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Why do people with kwashiorkor have big liver?
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Liver is not making lipoprotein to excrete fat synthesized in hepatocytes -> fatty liver
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What is the most striking abnormaluty of Kwashiorkor in clinical lab?
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hypoalbuminemia
- albumin level < 2.8 gm/dl |
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What are some clinical problems in protein/energy malnutrition?
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- depressed immune response: worsen/recurrent infection
- anemia |
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Which has more body store, fat soluble or water soluble vitamines?
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fat-soluble vitamines
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What is the transport form of vit A?
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retinol (alcohol)
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What is the storage form of vit A?
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retinyl (ester)
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What is the vision form of vit A?
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retinal (aldehyde)
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What is the form of vit A that aid in epithelial differentiation and growth, and is directly absorbed?
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retinoic acid (carboxylic acid)
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What is the form of vit A found in plant?
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carotene (provitamin A)
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What is this form of vit A?
- a linked vitamin A |
beta-carotene
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What is this form of vit A?
- natually occuring and synthetic analogues - not functionally active |
retinoids
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How long does the liver store vit A as ester for?
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6 months
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Functions of vit A.
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- maintain mucosal epithelial differentiation: prevent dryness, anti-cancer
- provide visual pigment (rhodopsin) - enhance immunity - anti-oxidant |
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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 |
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What is the effect of Vit A deficiency on GI epithelium?
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decreased goblet cells
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Which vitamin deficiency is this?
- xerophthlamia - xerosis - bitot spots, ulcers - keratomalacia (corneal softening) - impaired night vision |
vitamin A deficiency
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11-cis-retinal or trans-retinal?
- converts to rhodopsin |
11-cis-retinal
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Which vitamine can be used to treat AML, M3 subtype (APL)?
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Vitamin A
- differentiate hematopoietic white blood cells in bone marrow |
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An infant presents with vomiting, stupor, papilledema, loss of hair, peeling of skin, large liver, which vitamin toxicity is this?
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acute Vit A toxicity
- more common in infants - premature closure of fonanelles -> increased intracranial pressure -> headache, vomiting, stupor, papilledema. |
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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 |
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T/F: 80% of VitD need comes from endogenous synthesis in the skin.
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T.
Skin makes 7-dehydrocholesterol, need uv light to D3 (cholecalciferol) |
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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
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Which form of vit D is this?
- dietary form in plants |
ergocalciferol (D2)
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Functions of vit D.
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- maintain serum Ca and P level for bone mineralization
- prevents hypocalcemic tetany |
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T/F: Vit D is needed in both bone remodeling and epiphyseal plate mineralization.
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T.
- deficiency in adult cause osteomalasia - deficiency in kids cause rickets |
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General categories of causes of vit D deficiency.
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- 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) |
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Mechanism of vit-D dependent rickets type I.
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- defective 1-a-hydroxylase
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Mechanism of vit-D dependent rickets type II.
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defective vitD receptor
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What type of ricket is this?
- hypophosphatemia - normocalcemia - low to normal calcitriol |
X-linked hypophosphatemic rickets
- renal phosphate wasting and impaired intestinal ca absorption |
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Mechanism of tumor induced rickets/osteomalasia.
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secretion of PTHRP (osteolytic)
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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
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Excess vitD may cause what conditions?
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- hypercalcemia
- metastatic calcification - renal stones |
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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 |
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Name some causes of vitE deficiency.
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- abetalipoproteinemia: apoB needed for vitE transport
- cholestasis - cystic fibrosis (pancreas) - malabsorption - low birth weight in neonates |
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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) |
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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) |
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Vit K participated in activation of what coagulation factors, others?
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factors II, VII, IX, X
protein C and S osteocalcin * cofactor in carboxylase reactions |
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How does warfarin work as anticoagulant?
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block reduction from vitK epoxide to vitK -> less coagulation factors produced
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T/F: Primary vitK deficiency is more common in adults than secondary deficiency.
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F
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What are some causes of seconary vit K deficiency in adults?
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- malabsorption
- antiobiotics - liver disease - anticoagulation therapy |
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What are some primary causes of vit K deficiency in infants?
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- little transplacental transport
- sterile gut - breast milk low in vit K |
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What is the functionally active coenzyme form of B1 (thiamine)?
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thiamine pyrophosphate (TPP)
- oxidative phosphorylation of keto acids - cofactor for transketolase of pentose phosphate shunt (PPS) - maintain neural membranes and normal nerve conductions |
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What conditions can be caused by thiamine (B1) deficiency?
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- dry Beriberi: peripheral neuropathy
- wet Beriberi: myocardial damage - wernicke-Korsakoff syndrome |
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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 |
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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) |
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What is this vitamin deficiency?
- ophthalmoplegia - nystagmus - ataxia - deranged mental function - chronic alcohol consumption |
wernicke's encephalopathy
- lateral rectus muscle (CN6) often affected |
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What is this vitamin deficiency?
- retrograde amnesia - inability to acquire new information - confabulation - chronic alcohol intake |
koesakoff's psychosis caused by thiamine deficiency
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What anatomical lesion would you see in werneke-koesakoff lesion due to thiamine deficiency?
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- hemorrhage in mamillary bodies
- hemorrhage in periventricular region of the thalamus - degeneration in the anterior cerebellar vermis |
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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
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How to treat Beriberi?
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Give thiamine before IV glucose
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Which vitamine is this?
- cofactor in FAD reactions - cofactor at succinate dehydrogenase step of kreb's cycle |
riboflavin (B2)
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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 |
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What is this vitamine?
- NAD and NADP reactions - synthesized from tryptophan - tighly bound in maize |
niacin (B3)
- deficiency cause pollegra |
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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 |
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Who are at risk at developing pollegra (B3 deficiency)?
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- maize rich diet
- drugs: isoniazid, 6-MP - carcinoid tumor - harnup's disease (trp malabsorption) |
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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 |
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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 |
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What can cause pyridoxine deficiency?
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- alcoholic consumption
- estrogen - penicilllamine - isoniazid |
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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 |
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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 |
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What is this vitamin deficiency?
- skin purpura - easily bruised - bleeding gums - occur in adults |
adult scurvy (vitC) deficiency
- impaired collagen synthesis |
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What is the risk of taking megadoses of vitC?
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- uricosuria
- iron overload - acidosis with background renal disease - hemolysis in G-6-PD deficiency |
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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 |
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What is the vitamin deficiency?
- megaloblastic anemia - anemia corrected by folate, but neurologic problem persist |
B12 deficiency
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What is this nutritional deficiency?
- hemorrhagic dermatitis - acrodermatitis enteripathica - anorexia, diarrhea - growth retardation - hypogonadism - depressed wound healing - impaired immunity |
zinc
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What is this mineral?
- component of glutathione peroxidase - antioxidant - deficiency cause congestive cardiomyopathy in china |
selenium
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