Goljan: Nutritional Disorders

Front 1

Main difference between anorexia and bolumia?

Back 1

Anorexia - distorted body image

Bulemia - binge and purge

Front 2

VHY***
what are the big clinical complications associated w/ anorexia nervosa?

Back 2

Decreased gonadotropin releasing hormone (caused by dec. fat content)

OSTEOPOROSIS***caused by hypoestrinism

Front 3

what is the most common cause of death in anorexia nervosa?

Back 3

ventricaular arrhythmia

Front 4

What are the complications of bulemia?

Back 4

Acid injury to tooth enamel

metabolic alkalosis -...dangerous for inducing ventricular arrhythmia and cardiac death

Borehaves syndrome

Front 5

What is the BMI?

what BMI is considered obese?

Back 5

weight (kg)/Hight (m^3)

>30BMI

Front 6

What is the major complication of obesity?

Back 6

HTN - left ventricular hypertrophy and heart failure

Front 7

what are some of the other major complications of obesity?

Back 7

cancer - hyperestrinism (aromatiztion in the fat)...endometrial and breast cancer can result

Cholelithiasis (cholesterol stones)

T2DM

many others

Front 8

What gene is often defective in obesity?

Back 8

Leptin-this normally increases when adipose stores are adequate

Front 9

Define marasmus?

what is common w/ marasmus?

Back 9

They have a deficiency of both protein and calories

extreme muscle wasting - breakdown of muscles for energy and protein

Front 10

what are the major clinical findings of kwarshiorkor (inadequate protein intake)?

Back 10

Pitting edema and ascites - from loss of plasma oncotic pressure

Fatty liver - dec. synthesis of apolipoprotins (B-100), so VLDL can't get out.

Flaking skin

Copper colored hair

Front 11

Which are more toxic, water or fat soluble vitamins?

Back 11

fat soluble, because you pie out the water soluble ones

Front 12

What is the role of vitamin A children?

Back 12

needed for growth of children (bone and muslce), can have failure w/o it.

Front 13

follicular hyperkeratosis and bitot spots (squamous metaplasia of corneal epithelium) are both complications of ?

Back 13

vitamin A deficeincy

Front 14

what is the first sign of vitamin A deficiecny?

Back 14

night blindness

Front 15

what are the complications of vitamin deficeincy?

Back 15

impaired night vision and blindness (squamous metaplasia of the corneal epithelium, "bitot spots")
Follicular hyperkeratosis (loss of sebaceous gland function), pneumonia, growth retardation and renal calculi

Front 16

VHY**
Patient has papilledema and seizures, hepatits and bone pain what vitamin toxicity is this?

how do you tx this?

Back 16

Vitamin A - (TWO BIG AREAS ARE BRAIN AND LIVER***)

papilledema and seizures are from inc. intracranial pressure)

periosteal proliferation causes the bone pain.

Isotretinoin

Front 17

What are the causes of vitamin A deficeincy?

Back 17

diets lacking in yellow and green vegtables and fat malabsorption problems (e.g. cystic fibrosis)

Front 18

what is the clinical use of vitamin A?

Back 18

treatment of Acne and acute promyelocytic leukemia

Front 19

VHY**
what are the major functions of vitamin A?

Back 19

Normal night vision, potentiating differentiation of mucus-secreting epithelium (prevents Squamous metaplasia), stimulating the immune system, growth and reproduction (especially children)

Front 20

what are the number 1 and 2 global causes of blindess?

Back 20

1. chalmydia trachomatis

2. vitamin A - squamous metaplasia...softening of the cornea from squamous metaplasia

Front 21

VHY***
THere is a big game hunter who eats polar bear liver and develops headaches, dx?

Back 21

Vitamin A overdose causing increased intracranial pressure.

Front 22

What is the main transport storage form of vitamin A and what is it derived from?

Back 22

Retinol, derived from dieteray B-cartotene and retinol esters

Front 23

How can you tell excess vitamin A from jaundice if both tern the skin yellow?

Back 23

Sclera remains white w/ excess beta-carotene

Front 24

Patient presents w/ pathologic fractures, excess osteoid, bowed legs, what vitamin is deficient?

Back 24

Vitamin D

Front 25

How does vit. D effect adults compared to children?

Back 25

Children: rickets - soft bones (main function of Vit D is to mineralize bone)** results in pathologic fractures** craniotabes (soft skull bones) and excess osteoid (rachitic rosary, defective mineralization and overgrowth epiphyseal cartilage in ribs)...

Adults: ostomalacia w/ contious muscle contraction (tetany, not enough calcium is absorbed)

Front 26

Patient presents w/ hypercalcemia, metastatic calcification and renal calculi, what vitamin overdose has ocurred?

Back 26

Vitamin D

Front 27

Patient presents w/ hemolytic anemia, pripheral neuropathy, degeneration of posterior column (dec. joint sensation)and spinocerebellar tract (ataxia), what vitamin is deficient?

Back 27

Vitamin E (usually only seen in cystic fibrosis)

hemolytic anemia - because can't protect RBC membrane very well

Front 28

Patient has decreases synthesis of vitamin K dependent coagultion factors, synergistic w/ warfarin what vitamin is found to be in excess?

Back 28

Vitamin E

Front 29

VHY***
Newborn baby presents w/ CNS bleed and ecchymoses (hemorrhagic disease of the newborn) what vitamin is deficient?

Back 29

Vitamin K

Front 30

40 yr old man presents w/ Gi bleed, eccymoses, prolonged prothrombin time and partial thrmboplastin time, what vit. is deficient?

Back 30

Vit K

Front 31

A newborn breast feed baby appears jaundice and has hemolytic anemia, what vitamin is the mother taking in excess?

Back 31

Vit K

Front 32

what are the two sources by which we get vitamin D

Back 32

diet-cholecalciferol(fish) and ergocalciferol(plants)

**main component - photoconversion of lipid membrane is the first precursor to active vit. D

vitamin D is also reabsorbed in small intestine (jejunum)

Front 33

After we ingested or created vitamin D via sunlight conversion what is the next step of its metabolism?

Back 33

Hydroxylation in the liver to create 25-(OH)-D (25-hydroxyvitaminD)

Front 34

After Vit D has been hydroxylated in the liver at the P-450 what is the final step in making active Vitamin D?

Back 34

Kidney-hydroxylation by 1 alpha-hydroxylase (in the proximal tubule) to produce 1,25(OH)2-D

PTH is responsible for enzyme formation in the proximal tubule.

Front 35

What does the active form of vitamin D do?

Back 35

Increases reabsorbpion of caclium and phosphorus(necessary to minearlize bone because this is the solubility product) from the jejunum and from the distal renal tubules

Front 36

What are the functions of Vitamin D?

Back 36

1.Maintenace of serum calcium and phosphorus

2.Required for mineralization of epiphyseal cartilage and osteoid matrix (binds to a receptor causing alkaline phosphatase to be released)

3.stimulates conversion of macrophage stem cells into osteoclasts

Front 37

What is the most common cause of vitamin D deficeincy?

Back 37

renal failure

Front 38

what are some other common causes of Vitamin D deficiency?

Back 38

not enough sun exposure

fat malabsorption

chronic liver disease

enzyme induction of P-450 system casuing 25-OH-D to be degraded

Front 39

This vitamin serves as an antioxidant and protects the cell membrane from lipid peroxidation (breakdown by phospholipase A2) by free radicals and by low densitiy lipoproteins (neutralizes oxidzed LDL, thats what macrophages eat and form part of atherosclerotic plaques)?

Back 39

vitamin E

Front 40

VHY***
Where do we get vitamin K from?

Back 40

from our bacteria (they make K2 which is conveted in our body by epoxide reductase to the active form K1) and green vegtables

Front 41

VHY****
what is the most common cause of vitamin K deficiency in hospitals?

what are 3 other causes

Back 41

antibiotics, kill the bacteria and they can't make it.

others include newborn, poor diet and malabsorption problems

Front 42

How does coumarin and its derivaties work?

Back 42

they inhibit epoxide reductase which activates Vitamin K

Front 43

VHY*****
what is the function of vit. K?

Back 43

Gamma-carboxylation of glutamatamic acid residues of vitamin K dependent procagulants and anticoagulants...this allows the pro-coagulants to bind to calcium in fibrin clot formation (w/o it they can't participate in the clot)

Pro-coagulants - II(prothrombin), VII, IX and X

Anti-coagulants are protien C and S

Front 44

What does Rat posion contain?

Back 44

Coumarin derivatives

Front 45

VHY**
why do we give newborns vitamin K shot at birth?

Back 45

not enough bacterial colonization (which takes about 5 days) of our gut to make vit. K...if they don't have enough they can have a CNS bleed.

Front 46

what does PTH do?

Back 46

Reabsorption of Ca2+ in the early part of the distal tubule (takes turn through a Na channel w/ the help PTH)

Dec. reabsorption of phosphorus in the proximal tubule and HCO3

makes 1-alpha-hydroxylase in the proximal tubule

Front 47

VHY**
most calcium kindey stone fomers have Hypercalciuria**(MC metabolic abnormality of these people), because they reabsorb to much caclium from there gut and try to pee it out as a way to get rid of it, so what can you do to treat this?

Back 47

hydrochlorathiazide-prevents Na reabsorption and sucks the calcium out of the urine preventing stone formation

Front 48

VHY**
What drug has the potential complication of hypercalcemia?

Back 48

hydrochlorathizide, because as you block the Na from entering, Ca2+ does instead

Front 49

Where are the bone receptors for Vit D, PTH and Calcitonin

Back 49

vit D main function is to mineralized bone and its receptor is on the osteoblasts causes the release of alkaline phosphatase...which makes solubility prodcuts to mineralize hormone

PTH receptor is on the osteoblasts...releasing IL-1 activating ostoclasts

calcitonin has a receptor on osteoclasts and inhibits it

Front 50

VHY**
What is the mechanism of osteoporosis in postmenapausal women?

Back 50

more bone breakdown then formation because estrogen is gone to keep IL-1 in check (in men it is testosterone)

Front 51

Vitamin D main function

Back 51

mineralize bone

Front 52

Patine taking phenytoin has hypocalcemia, why?

Back 52

phenytoin inc. the CYP-450 system and causes degredation of the 25-OH-D

Front 53

WHat is the most common cause of chronic renal failure

Back 53

diabetes

Front 54

Patient comes home from hospital and is taking warfarin w/in the normal limits but INR is off the chart, why?

Back 54

Taking to much Vitamin E which is synergistic w/ warfarin

Front 55

Newborn of uneventful delivery develops develops hemorrhagic diathasis (unusual susceptibility to bleeding) after 6 days of being brestfeed what is the DX, the child is otherwise healthy?

Back 55

Vitamin K deficeincy because not enough vit. k in breast milk

Front 56

Kid who lived some elderly people developed a hemorrhagic diathesis, why?

Back 56

Got a hold of warfarin and developed vit K deficiency

Front 57

kid who ate rat poison, how do you treat it?

Back 57

intramuscular Vitamin K

Front 58

VHY**
Patient presents w/ tea and toast diet (malnourished) and get bleeding of their gums when they brush their teeth, DX?

Back 58

Vit. C deficiency

weak collagen because you can't form cross bridge of collagen (can't hydroxylate proline and lysine residues in the golgi). (blood vessels are unstable and they rupture easily in the gums, TYPE I)

Front 59

If a patient has a perifollicular hemorrhage, skin eccymoses and hemarthrosis, DX?

Back 59

Vitamin C deficiency

Front 60

glossitis (looks smooth), poor wound healing, and loosened teeth, DX?

Back 60

excess vitamin C

Front 61

VHY**
What is a major complication of vitamin C deficiency? Many people in the US take to much calcium.

what other vit. overdose also causes this?

Back 61

REnal calculi composed of uric acid.

Vit D can also cause stone formation

Front 62

Vitamin C is a great ancillary treatment of what disease

Back 62

Met hemaglobin C

Front 63

vitamin C is the Co-factor in the formation of?

Back 63

catecholamines Epinehrine to Norepinephrine

Front 64

What biochemicla rxn is thiamine (B1) a co-factor for? what happens if you are deficient in thiamine?

Back 64

cofactor for biochemical rxns that make adenosine triphosphate (ATP)

e.g. pyruvate dehydrogenase***..leads to production of acetyl CoA...leads to citrate so if its not around you get ATP deficiency.

Front 65

what are the causes of thiamine (B1) deficeincy

Back 65

Chronic alcoholism***(MCC) and deit of nonenriched rice (developing countries)

Front 66

Dry beriberi (peripheral neurpathy), wernickes syndrome (ataxia, confusion, nystagmus and mamilary body hemorrhage) and Korsakoffys syndrome (antegrade and retrograde amnesia) are all associated w/ what type of vitamin deficiency, why do these symptoms develop?

Back 66

Thiamine or vitamin B deficeincy because need a lot of ATP to make Myelin...in all of these cases you have demyelination of either peripheral or central nerves: foot drop and wrist drop - demyelination of peripheral nerves, demyelination of limbic system get korsakoffs syndrome...

Front 67

Wet berberi-congestive heart failure w/ biventricular failure is caused by which vitamin deficiency?

what is the treatment

Back 67

Vitamin B1 - need lots of ATP to run the heart and you don't have it w/ this deficiency.

IV thiamine in some cases makes it reversible

Front 68

VHY**ON EVERY BOARD
Guy comes into the ER and needs an IV so they give him 5% dextrose w/ normal saline and then the patient develops confusion, opthalmoplegia, nystagmus, what happen?

How do you present this?

Back 68

acute Wernickes syndrome: the glucose caused the rest of the thiamine to be used up when pyruvate tried to enter the TCA...obviously they were all ready severly depleated.

prevent by giving them thiamine in the IV.

Front 69

any patient that comes into the ER in either comatose or semi-comatose state what are the three things that you give them when giving and IV?

Back 69

IV thiamine before you give any IV w/ glucose

50% glucose in case of hypoglycemia

Nalaxone in case it is an overdose.

Front 70

VHY***
patient presents w/ rash in sun exposed areas (dermatitis), diarrhea, and dementia

Back 70

Pellagra - Niacin deficiency

Front 71

what are the functions of niacin?

Back 71

Part of the NAD and NADP rxns so it is very important

Front 72

What are the causes of deficeincy in Niacin?

Back 72

Dietary deficeincy and tryptophan deficeincy (essential amino acid)

Front 73

What can tryptophan be used to synthesize?

Back 73

Niacin (B3, nicotinic acid) and seretonin

NOTE: see how you can get pellagra during a carcinoid syndrome using tryptophan to make Seretonin and no NIACIN

Front 74

What is the therapeutic use of niacin

Back 74

very cheap lipid lowering drug, take it w/ an aspirin to prevent flushing (caused by vasodilationcholesterol.

Front 75

What is the DOC for elevated TG and cholesterol (familial combined hyperlipidemia)

Back 75

Niacin (B3 or nicotinic acid)

Front 76

Patient is on a corn based diet, what viatmin are they going to be deficient in?

Back 76

Niacin (B3 or nicotinic acid)

Front 77

VHY**
what is riboflavin used in?

Back 77

FAD and FMN reaction, riboflavin (B2) is the co-factor in these reaction.

RIboflavin is the co-factor in glutothione reductase

Front 78

what the reactions that pyridoxine (B6) is used in?

Back 78

Transamination (like using alanine during fasting states make glucose), heme synthesis and neurotransmitter synthesis

Front 79

what is the most common cause of B6 deficiency?

Back 79

Isoniazid

Front 80

Patient has conral neovascularization, flossitis, cheilosis (cracked lips) and angular stomatitis (fissuring at the angle of the lips), what viatmin is deficiency?

Back 80

RIboflacvin (B2)

Front 81

patient presents w/ micorcytic anemia w/ ringed sideroblasts (sideroblastic anemia), convulsions and peripheral neuropathy, what vitamin is deficient?

Back 81

Pyridoxine (B6)

Front 82

what is the most common cause of vitamin B12 deficeincy?

Back 82

Pernicious anemia

Front 83

Patient presents w/ a megaloblastic anemia, neurologic disease (posteriorl column demylin.) and glossitis, Dx?

Back 83

pernicious anemia causing vitamin B12 deficiency.

Front 84

what rxn's is Cobalamin (vit. B12) used in?

Back 84

DNA sythesis, propionate (odd cahin fatty acid) metabolism

Front 85

what are the causes of vitamin B12 def.

Back 85

strict vegan diet, pernicious anemia and Terminal ileal disease (e.g. crohns), and bacterial overgrowth

Front 86

Patient presentw w/ dermatitis, alopecia and lactic acidosis, what vitamin is deficient?

Back 86

Biotin

Front 87

what are the functions of biotin?

Back 87

Co-factor in carboxylase deficiencies...e.g. pyruvate carboxylase (conversion of pyruvate to oxaloacetate)...if you can't do this you can't do gluconeogenesis and make lactic acid instead...

Front 88

What are the causes of biotin deficiency?

Back 88

eating to many raw eggs (they bind biotin)

Taking antibiotics

Front 89

patient hs impaired glucose tolerance and peripheral neuropathies, which trace element can cause this?

Back 89

Chromium - it helps maintain normal glucose (glucose tolerance factor)

Front 90

Patient has an increase in dental caries, what trace element deficiency is responsible?

Back 90

fluoride

Front 91

patient presents w/ chalky white deposits on the teeth and on x-ray you see calcification of the ligaments, DX?

Back 91

Fluoride excess (intoxication)

Front 92

Patient on total perenteral nutrition develops poor wound healing, what trace element is responsible?

what enzyme is it a co-factor for?

Back 92

Copper deficeincy (MCC is TPN)

lysl-oxidase**-involved in cross-linking collagen and elastic tissue.

Front 93

A deficeincy of this trace element can result in aortic dissection?

Back 93

copper deficiency

lysl oxidase again-it not only corss-links collagen but also elastic tissue

Front 94

VHY***
A deficiency of this trace metal causes muscle pain and weakness, dialted (congestive) cardiomyopathy?

Back 94

Selenium

Front 95

VHY*******
This trace element is a component of glutothione peroxidase-the anti-oxidant that converts peroxide to water using reduced glutathione?

Back 95

Selenium-considered an anti-oxidant

Front 96

VHY***
Selenium deficiency is usually caused by?

Back 96

TPN

Front 97

VHY***ON EVErY TEsT
Older person has dysgeusia (abnormal taste) and anosmia, rash on face and poor wound healing,
what trace element is deficient what enzyme is this a co-factor for?

All diabetics are deficient in this?

Back 97

Zinc-cofactor for metalloenzymes (collagenase in wound remodeling)

Front 98

VHY***
what can cause zinc deficiency?

Back 98

alcoholism, diabetes and chronic diarrhea

Front 99

VHY
when would you restrict protien in your diet?

Back 99

kidney failure (don't want to have the kidney deal w/ urea)

cirrhosis (defective urea cycle so can't metabolize ammonia)

Front 100

WHat happens to urea in our gut (this happens when we are braking down protien?
what signs and symptoms do you see?

Back 100

UREA converted to ammmonia by anerobes of the gut then it is reabsorbed and goes to the liver where it becomes UREA and then is excreted by the kidney.

mental status abnormalities (stuff associeated w/ hepatic encephalopathy)