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Step 1 3.1.13 (3)

Nutrition Actually

Which vitamins are fat soluable? What does their absorbtion depend upon? ADEK. absorbtion depends on gut and pancreas
What vitamin is needed to make TPP? thiamine=B1
What vit is needed to make FAD and FMN? riboflavin=B2
What vit is needed to make NAD+? niacin=B3
That vit is needed to make CoA? B5=pantothenic acid
The vit is needed to make PLP? pyridoxine=B6
What is cobalamin? cobalamin=vit B12
What are 3 common sx of B vit deficiencies? dermatitis, glossitis, diarrhea
What B vit are stored in the liver? B12 and folate
What are the usual biologic functions fo vitamin A? antioxidant, constituent of visual pigments, needed for normal differentiation of epithelial cells, prevents squamous metaplasia
where do you find vit A? liver and leafy vegetables
What diseases are tx with vit A? AML, measels
A pt has night blindness and dry skin. What Vit is deficient? Vitamin A (retinol)
A pt has arthralgias, fatigue, HA, skin changes, sore throat and allopecia. What Vit is in excess? Vit A. Think bear hunter with HA
What must be done before isotretinoin is proscribed for acne? pregnancy test as vit A is teratogenic (cleft palate and cardiac abnormalities)
What are 4 key reactions for which B1 thiamine is a cofactor? TPP is a cofactor in : 1. pyruvate DH in glycolysis 2. alphaketoglutarate DH in TCA cycle 3. Transkelotase in the HMP shunt 4. Branched cahin AA DH
What happens if you give glucose alone to someone with B1 thiamine deficiency? you can make it worse, give thiamine!
A patient has confusion, ophthalmoplegia, ataxia, confabulation, and permanent memory loss. Dx and where would you most likely seem neurologic damage? Wernmicke-Korsakoff syndrome from thiamine (B1) deficiency. see damage in medial dorsal nucleus of thalamus, and mammilary bodies
Who gets vit B1 thiamine deficiency? malnutrition and alcoholism
What is the difference between dry and wet beriberi? both are deficiencies of b1 thiamine., dry: polyneuritis and muscle wasting. wet: dilated cardiomyopathy and edema
What reaction is B2 riboflav in a cofactor for? oxidation and reduction in FADH2
A patient has inflammation o the lips and scaling and fissures at the corners of the mouth. Corneal vascularization is also seen. Dx? B2 riboflavin deficiency
What reaction is vit B3 niacin involed in? What is it synthesized from and what vitamin is required? redox reactions. synthesized from tryptophan. synthesis requires B6
Pt with glossitis and pellagra. also diarrheara, dermatitis, dementia. Cause? Vit B4 niacindeficiency
What 3 things can cause a B3 niacin deficiency? Hartnup disease ( decr tryptophan absorbtion), carcinoid syndrome (incr tryptophas metabolism) and INH (decr B6)
B3 excess used to tx hyperlipidemia migh cause what SE? flushing
What are the key cofactor ractions for vit B5 pantothenate? CoA needed for acyl transfers and fatty acid synthase
A patient with dermatitis, enteritis, alopecia, adrenal insufficiency has what deficiency? B5 pantothenate
What reactions is B6 pyridoxine a cofactor for? pyridoxal phosphate is a cofactor in transamination, decarboxylation, glycogen phosphorylase
What are 5 key thoings that B6 pyridoxine is required to synthesize? 1.cystathionine, heme, niacin, GABA, histamine
A patient with convulsions, hyperiritability, peripheral neuropathy, sideroblastic anemia has what def? B6 pyridoxine defieicny
What meds could induce a B6 pyridoxine defieincy? INH and oral contraceptives
Why does B6 pyridoxine cause a sideroblastic anemia? impairs Hb synthesis and results in an Fe excess
What reactions is B12 cobalamin a cofactor for? for homocysteine methyltransferase which transfers methyls as methylcobalamin an d for methymalonyl CoA mutase
What worm can cause a B12 deficiency? Diphyllobothrium latum
What processes could cause a B12 cobalamin deficiency by having a lack of intrinsic factor? pernicious anemia, gastric bypass
What disease could cause a B12 deficiency by having a lack of terminal ileum? Crohn's disease
On PBS there is a macrocytic, megaloblastic anemia, hypersegmented PMN and parasthesia with subacut combined degeneration. Dx? B12 cobalamin deficiency
What vitamin is needed to convert methylmalonyl CoA into succinyl coA for odd chain FA metabolism? B12
What vit is required to convert succinyl coA to Hb? B6
What reactions is folate a key cofactor in? coverted to THF which is a coenyme for 1 carbon transfer and methylation rwxtions. important for synthesizing nitrogenous bases in DNA and RNA
Where does folate come from? green leaves
Pt has macrocytic, megaloblastic anemia with no neurologic sx. Dx? Folate deficiency
Who gets folate deficiency? pregnant women, alcoholic
What vitamin deficiency might phenytoin, sulfonamides or methotrexate cause? Folate deficiency
Why give folate in pregancy? to prevent neural tube defects
What is the function of S-adenosyl methionine? What vitamins are needed? SAM tranfers methy units, requires regeneration of methionine to work, which requires both B12 (homocysteine methytransferase) and folate (THF to transfer methyl). Key for conversion of NE to Epi
What 3 key enzymes is biotin a cofactor for? carboxylation enzymes (add 1 C). 1. Pyruvate carboxylase (pyruvate to oxaloacetate) 2. Acetyl CoA carboxylase (acetyl CoA to malonyl CoA 3. PropionylCoA carboxylase (proponyl CoA to methymalonyl CoA
What is seen in deficiency of biotin? How could it be cause? see dermaitis, alopecia and enteritis. seen with abtx or excessive ingestion of raw eggs (avidin binds biotin)
What are 3 key roles of vit C (ascorbic acid)? antioxidant 1. facilitates iron absorbtion by keeping it as fe 2+ 2. Neccessary for hydroxylation of proline and lysine in collagen synthesis 3. neccessary for dopamine Beta hydroxylase which converts Dopamine to NE
Pt comes in with swollen gums, bruising, hemearthrosis, anemia and poor wound healing. possibly a weak immune response. Dx? Scurvy due to lack of vit C and inability to hydroxylate proline and lysine
Pt comes in with n/v, diarrhea, fatigue, sleep problems. and could haveexacerbation of hereditary hemochromatosis. What vit could be in excess? Vit C (can make iron excess worse)
What vit D do you get from plants? ergocalciferol, vit D2
What vitD do you get from mild or in sun exposed skin? cholecalciferol, vit D3.
what are the storage and active froms of vit D? storage: 25-OH D3. 1,25 (OH)2 D3 (calcitriol is active)
What is the action of vit D? incr intestinal absorbtion of Ca++ and phosphate, incr bone mineralization
Bending bones in children, osteomalacia in adults is caused by? Vit D deficiency
What child might be in danger of vit D deficiency? one that is breast fed without vit D dupplements
Pt has hypercalcemia, hypercalciuria, loss of appetite and stupor. Dx? Vit D excess
Why might vit D be in excess in sarcoid? incr activation of vit D by epitheloid macrophages
What is the function of vit E? antioxidant which protects from free radical damage (esp in eryhtrocytes)
incr fragility of erythrocytes (hemolytic anemia), muscle wekness, posterior column and spinocerebellar tract demyelination. What Vit deficienct? Vit E
what is the function of vit K? catalyzes gamma carboxylation of glutamic acid residues on various proteins concerned with blood clotting, synth by intestinal flora
What clotting factors do you need vit K for? II, VII, IX, X protein C and S.
What drug is a vit K antagonist? warfarin
A neonate has a hemorrhage with incr PT and incr PTT but has normal bleeding time. Dx and Tx? Vit K deficiency (this is why they give shot, also vit K NOT in breast milk)
What is seen in zinc deficiency? delayed wound healing, hypogonadism, decr in adult hair (axillary, facial, pubic), dysguesia, anosmia. could prediscopse to cirrhosis
Created by: tjs2123



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