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Step 1 3.1.13 (3)
Nutrition Actually
| Question | Answer |
|---|---|
| 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 |
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tjs2123
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