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100 Cards in this Set
- Front
- Back
Main difference between anorexia and bolumia?
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Anorexia - distorted body image
Bulemia - binge and purge |
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VHY***
what are the big clinical complications associated w/ anorexia nervosa? |
Decreased gonadotropin releasing hormone (caused by dec. fat content)
OSTEOPOROSIS***caused by hypoestrinism |
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what is the most common cause of death in anorexia nervosa?
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ventricaular arrhythmia
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What are the complications of bulemia?
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Acid injury to tooth enamel
metabolic alkalosis -...dangerous for inducing ventricular arrhythmia and cardiac death Borehaves syndrome |
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What is the BMI?
what BMI is considered obese? |
weight (kg)/Hight (m^3)
>30BMI |
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What is the major complication of obesity?
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HTN - left ventricular hypertrophy and heart failure
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what are some of the other major complications of obesity?
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cancer - hyperestrinism (aromatiztion in the fat)...endometrial and breast cancer can result
Cholelithiasis (cholesterol stones) T2DM many others |
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What gene is often defective in obesity?
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Leptin-this normally increases when adipose stores are adequate
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Define marasmus?
what is common w/ marasmus? |
They have a deficiency of both protein and calories
extreme muscle wasting - breakdown of muscles for energy and protein |
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what are the major clinical findings of kwarshiorkor (inadequate protein intake)?
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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 |
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Which are more toxic, water or fat soluble vitamins?
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fat soluble, because you pie out the water soluble ones
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What is the role of vitamin A children?
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needed for growth of children (bone and muslce), can have failure w/o it.
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follicular hyperkeratosis and bitot spots (squamous metaplasia of corneal epithelium) are both complications of ?
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vitamin A deficeincy
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what is the first sign of vitamin A deficiecny?
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night blindness
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what are the complications of vitamin deficeincy?
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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 |
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VHY**
Patient has papilledema and seizures, hepatits and bone pain what vitamin toxicity is this? how do you tx this? |
Vitamin A - (TWO BIG AREAS ARE BRAIN AND LIVER***)
papilledema and seizures are from inc. intracranial pressure) periosteal proliferation causes the bone pain. Isotretinoin |
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What are the causes of vitamin A deficeincy?
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diets lacking in yellow and green vegtables and fat malabsorption problems (e.g. cystic fibrosis)
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what is the clinical use of vitamin A?
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treatment of Acne and acute promyelocytic leukemia
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VHY**
what are the major functions of vitamin A? |
Normal night vision, potentiating differentiation of mucus-secreting epithelium (prevents Squamous metaplasia), stimulating the immune system, growth and reproduction (especially children)
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what are the number 1 and 2 global causes of blindess?
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1. chalmydia trachomatis
2. vitamin A - squamous metaplasia...softening of the cornea from squamous metaplasia |
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VHY***
THere is a big game hunter who eats polar bear liver and develops headaches, dx? |
Vitamin A overdose causing increased intracranial pressure.
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What is the main transport storage form of vitamin A and what is it derived from?
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Retinol, derived from dieteray B-cartotene and retinol esters
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How can you tell excess vitamin A from jaundice if both tern the skin yellow?
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Sclera remains white w/ excess beta-carotene
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Patient presents w/ pathologic fractures, excess osteoid, bowed legs, what vitamin is deficient?
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Vitamin D
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How does vit. D effect adults compared to children?
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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) |
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Patient presents w/ hypercalcemia, metastatic calcification and renal calculi, what vitamin overdose has ocurred?
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Vitamin D
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Patient presents w/ hemolytic anemia, pripheral neuropathy, degeneration of posterior column (dec. joint sensation)and spinocerebellar tract (ataxia), what vitamin is deficient?
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Vitamin E (usually only seen in cystic fibrosis)
hemolytic anemia - because can't protect RBC membrane very well |
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Patient has decreases synthesis of vitamin K dependent coagultion factors, synergistic w/ warfarin what vitamin is found to be in excess?
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Vitamin E
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VHY***
Newborn baby presents w/ CNS bleed and ecchymoses (hemorrhagic disease of the newborn) what vitamin is deficient? |
Vitamin K
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40 yr old man presents w/ Gi bleed, eccymoses, prolonged prothrombin time and partial thrmboplastin time, what vit. is deficient?
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Vit K
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A newborn breast feed baby appears jaundice and has hemolytic anemia, what vitamin is the mother taking in excess?
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Vit K
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what are the two sources by which we get vitamin D
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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) |
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After we ingested or created vitamin D via sunlight conversion what is the next step of its metabolism?
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Hydroxylation in the liver to create 25-(OH)-D (25-hydroxyvitaminD)
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After Vit D has been hydroxylated in the liver at the P-450 what is the final step in making active Vitamin D?
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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. |
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What does the active form of vitamin D do?
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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
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What are the functions of Vitamin D?
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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 |
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What is the most common cause of vitamin D deficeincy?
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renal failure
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what are some other common causes of Vitamin D deficiency?
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not enough sun exposure
fat malabsorption chronic liver disease enzyme induction of P-450 system casuing 25-OH-D to be degraded |
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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)?
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vitamin E
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VHY***
Where do we get vitamin K from? |
from our bacteria (they make K2 which is conveted in our body by epoxide reductase to the active form K1) and green vegtables
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VHY****
what is the most common cause of vitamin K deficiency in hospitals? what are 3 other causes |
antibiotics, kill the bacteria and they can't make it.
others include newborn, poor diet and malabsorption problems |
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How does coumarin and its derivaties work?
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they inhibit epoxide reductase which activates Vitamin K
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VHY*****
what is the function of vit. K? |
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 |
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What does Rat posion contain?
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Coumarin derivatives
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VHY**
why do we give newborns vitamin K shot at birth? |
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.
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what does PTH do?
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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 |
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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? |
hydrochlorathiazide-prevents Na reabsorption and sucks the calcium out of the urine preventing stone formation
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VHY**
What drug has the potential complication of hypercalcemia? |
hydrochlorathizide, because as you block the Na from entering, Ca2+ does instead
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Where are the bone receptors for Vit D, PTH and Calcitonin
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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 |
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VHY**
What is the mechanism of osteoporosis in postmenapausal women? |
more bone breakdown then formation because estrogen is gone to keep IL-1 in check (in men it is testosterone)
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Vitamin D main function
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mineralize bone
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Patine taking phenytoin has hypocalcemia, why?
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phenytoin inc. the CYP-450 system and causes degredation of the 25-OH-D
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WHat is the most common cause of chronic renal failure
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diabetes
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Patient comes home from hospital and is taking warfarin w/in the normal limits but INR is off the chart, why?
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Taking to much Vitamin E which is synergistic w/ warfarin
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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?
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Vitamin K deficeincy because not enough vit. k in breast milk
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Kid who lived some elderly people developed a hemorrhagic diathesis, why?
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Got a hold of warfarin and developed vit K deficiency
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kid who ate rat poison, how do you treat it?
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intramuscular Vitamin K
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VHY**
Patient presents w/ tea and toast diet (malnourished) and get bleeding of their gums when they brush their teeth, DX? |
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) |
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If a patient has a perifollicular hemorrhage, skin eccymoses and hemarthrosis, DX?
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Vitamin C deficiency
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glossitis (looks smooth), poor wound healing, and loosened teeth, DX?
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excess vitamin C
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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? |
REnal calculi composed of uric acid.
Vit D can also cause stone formation |
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Vitamin C is a great ancillary treatment of what disease
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Met hemaglobin C
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vitamin C is the Co-factor in the formation of?
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catecholamines Epinehrine to Norepinephrine
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What biochemicla rxn is thiamine (B1) a co-factor for? what happens if you are deficient in thiamine?
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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. |
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what are the causes of thiamine (B1) deficeincy
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Chronic alcoholism***(MCC) and deit of nonenriched rice (developing countries)
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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?
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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...
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Wet berberi-congestive heart failure w/ biventricular failure is caused by which vitamin deficiency?
what is the treatment |
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 |
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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? |
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. |
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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?
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IV thiamine before you give any IV w/ glucose
50% glucose in case of hypoglycemia Nalaxone in case it is an overdose. |
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VHY***
patient presents w/ rash in sun exposed areas (dermatitis), diarrhea, and dementia |
Pellagra - Niacin deficiency
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what are the functions of niacin?
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Part of the NAD and NADP rxns so it is very important
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What are the causes of deficeincy in Niacin?
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Dietary deficeincy and tryptophan deficeincy (essential amino acid)
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What can tryptophan be used to synthesize?
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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 |
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What is the therapeutic use of niacin
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very cheap lipid lowering drug, take it w/ an aspirin to prevent flushing (caused by vasodilationcholesterol.
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What is the DOC for elevated TG and cholesterol (familial combined hyperlipidemia)
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Niacin (B3 or nicotinic acid)
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Patient is on a corn based diet, what viatmin are they going to be deficient in?
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Niacin (B3 or nicotinic acid)
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VHY**
what is riboflavin used in? |
FAD and FMN reaction, riboflavin (B2) is the co-factor in these reaction.
RIboflavin is the co-factor in glutothione reductase |
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what the reactions that pyridoxine (B6) is used in?
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Transamination (like using alanine during fasting states make glucose), heme synthesis and neurotransmitter synthesis
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what is the most common cause of B6 deficiency?
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Isoniazid
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Patient has conral neovascularization, flossitis, cheilosis (cracked lips) and angular stomatitis (fissuring at the angle of the lips), what viatmin is deficiency?
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RIboflacvin (B2)
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patient presents w/ micorcytic anemia w/ ringed sideroblasts (sideroblastic anemia), convulsions and peripheral neuropathy, what vitamin is deficient?
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Pyridoxine (B6)
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what is the most common cause of vitamin B12 deficeincy?
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Pernicious anemia
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Patient presents w/ a megaloblastic anemia, neurologic disease (posteriorl column demylin.) and glossitis, Dx?
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pernicious anemia causing vitamin B12 deficiency.
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what rxn's is Cobalamin (vit. B12) used in?
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DNA sythesis, propionate (odd cahin fatty acid) metabolism
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what are the causes of vitamin B12 def.
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strict vegan diet, pernicious anemia and Terminal ileal disease (e.g. crohns), and bacterial overgrowth
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Patient presentw w/ dermatitis, alopecia and lactic acidosis, what vitamin is deficient?
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Biotin
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what are the functions of biotin?
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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...
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What are the causes of biotin deficiency?
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eating to many raw eggs (they bind biotin)
Taking antibiotics |
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patient hs impaired glucose tolerance and peripheral neuropathies, which trace element can cause this?
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Chromium - it helps maintain normal glucose (glucose tolerance factor)
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Patient has an increase in dental caries, what trace element deficiency is responsible?
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fluoride
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patient presents w/ chalky white deposits on the teeth and on x-ray you see calcification of the ligaments, DX?
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Fluoride excess (intoxication)
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Patient on total perenteral nutrition develops poor wound healing, what trace element is responsible?
what enzyme is it a co-factor for? |
Copper deficeincy (MCC is TPN)
lysl-oxidase**-involved in cross-linking collagen and elastic tissue. |
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A deficeincy of this trace element can result in aortic dissection?
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copper deficiency
lysl oxidase again-it not only corss-links collagen but also elastic tissue |
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VHY***
A deficiency of this trace metal causes muscle pain and weakness, dialted (congestive) cardiomyopathy? |
Selenium
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VHY*******
This trace element is a component of glutothione peroxidase-the anti-oxidant that converts peroxide to water using reduced glutathione? |
Selenium-considered an anti-oxidant
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VHY***
Selenium deficiency is usually caused by? |
TPN
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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? |
Zinc-cofactor for metalloenzymes (collagenase in wound remodeling)
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VHY***
what can cause zinc deficiency? |
alcoholism, diabetes and chronic diarrhea
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VHY
when would you restrict protien in your diet? |
kidney failure (don't want to have the kidney deal w/ urea)
cirrhosis (defective urea cycle so can't metabolize ammonia) |
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WHat happens to urea in our gut (this happens when we are braking down protien?
what signs and symptoms do you see? |
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) |