560I Additional Info Flashcards by Monica Salvatierra

Regarding Case 1 in the Course Materials supplied for this week, the patient’s complaint of difficulty with weight control is best explained by which finding?

Excessive Bacteroides sp.
Insufficient levels of E. coli
Fungal infection
Excessive Lactobacillus sp.

Excessive Lactobacillus sp…..this is due to the Firmicutes/Bacteroides ratio….Lactobacillus is a Firmicutes species, and high ratio of F:B can increase weight gain

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regarding Case 2 in the Course Materials supplied for this week, which result would draw your attention to the potential need of further testing for Celiac disease?

Elevated Anti-gliadin sIgA
Elevated pH
Presence of aacA drug resistance gene
Elevated Valerate %

Elevated Anti-gliadin sIgA

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How does the stimulation of hepatic cytochrome P450 activity by compounds in cigarette smoke illustrate the hormesis model of toxicant effects?

All compounds in cigarette smoke are toxic at all concentrations
Cytochrome P450 creates non-toxic compounds from most compounds in cigarette smoke
Very low doses of a toxic compound can have favorable effects
Cigarette smoke is only toxic under certain dietary conditions

Very low doses of a toxic compound can have favorable effects

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Why would a high protein diet be ill-advised for the patient whose laboratory report indicates a pathological detoxifier pattern?

Phase I detoxification needs to be stimulated
Pathological detoxifiers have difficulty with ammonia clearance
Methylation pathways would be overloaded
It would exacerbate the effects of low Phase II detoxification capacity

It would exacerbate the effects of low Phase II detoxification capacity… because protein stimulates phase 1, and it is phase 2 can’t keep up

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What urinary porphyrin becomes UNIQUELY elevated in urine due to mercury toxicity?

Uroporphyrin I & III
Precoproporphyrin
Protoporphyrin
Coproporphyrin

Precoproporphyrin, due to Hg blocking UROD and then CPOX acting on pentacarboxy to generate procopro (or ketoisocopro) which can go nowhere

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Which of the following is the most common reason for finding elevated benzoic acid in urine?

Hepatic glycine conjugation capacity has been exceeded.
The liver is converting more toluene into benzoic acid.
Pantothenic acid supplementation has been increased
Hepatic coenzyme A levels are increasing.

Hepatic glycine conjugation capacity has been exceeded.

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Which type of organotoxin is famous for originating from soft plastic products?

Phthalates
Organophosphates
Volatile solvents
PCBs

Phthalates

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Ammonia detoxification is not described by Phase I and Phase II reactions because

It is conjugated before it is oxidized for its major pathway of detoxification.
It does not require oxidation and conjugation for clearance.
It requires only oxidation in order to be cleared.
Ammonia leaves the body primarily as exhaled gases.

It does not require oxidation and conjugation for clearance. IT goes through the urea cycle

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Accumulation of which compound tends to produce reductive stress?

GSH
NADH
NAD+
BH4

NADH

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The designation (A856G) conveys what information?

At base position 856 in the related gene there is a single nucleotide polymorphism due to replacement of adenosine by guanosine.
At position 856 in the expressed protein glutamic acid is present instead of the normal arginine residue.
The wild type gene contains the A-G pair at position 856.
A total genome analysis found 856 A-G SNP alterations among the 23 human chromosomes

At base position 856 in the related gene there is a single nucleotide polymorphism due to replacement of adenosine by guanosine.

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If a patient is found to be homozygous for SNP that causes lowered activity of the enzyme required for conversion of dopamine to epinephrine, what laboratory report abnormality would show metabolic confirmation of the effect?

High urinary vanilmandelic acid
Low urinary vanilmandelic acid
High urinary 5-hydroxyindoleacetic acid
Low urinary pyroglutamic acid

Low urinary vanilmandelic acid

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Which response describes the level at which microRNAs act to affect processes like the uptake of micronutrients such as iron?

Preventing the formation of ribosomal RNA
Shifting gene products due to the presence of SNPs
Alteration of gene expression rates
Changing protein structures by modifying amino acid side chains

Alteration of gene expression rates

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Which of the following is true of a laboratory result that lies in the 5th quintile?

Eighty percent or more of the reference population has values less that this result
There are four quintiles above the value for this result.
This result may be presumed to be within normal limits.
According to standard clinical laboratory definitions, this result would necessarily be considered abnormal.

Eighty percent or more of the reference population has values less that this result

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For optimal wellness assurance, which of the following is the preferred stage of nutrient deficiency detection?

Diagnosed pathology
Impaired tissue function
Morphological changes
Biochemical alterations

Biochemical alterations

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Which abnormality is an indication of potential BH4 deficiency?

Elevated urinary succinate
Elevated urinary xanthurenate
Elevated plasma Phe/Tyr ratio
Elevated serum PIVKA II levels

Elevated plasma Phe/Tyr ratio (BH4 is required to convert Phe to Tyr)

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A patient with a low urinary N-methylnicotinamide is a candidate for which nutrient addition?

Vitamin B3
Vitamin C
Vitamin B2
Vitamin B1

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For a patient with elevated homocysteine, intervention may be focused on which specific nutrient when elevated formiminoglutamate also is found?

5-Methyltetrahydrofolate
Pantothenic acid
Vitamin B2
Vitamin B6

5MTHF

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Which of the following is a function NOT served by the single carbon pool?

Delivery of formyl groups to form purines
Delivery of methylene groups to form pyrimidines
Delivery of methyl groups to form SAMe
Delivery of reducing equivalents to form BH4

Delivery of reducing equivalents to form BH4

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Early dietary deficiency states of what essential element has been proposed to be revealed by elevated levels in hair?

Chromium
Zinc
Calcium
Manganese

calcium

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Which of the following describes the ultimate event that results in greater intestinal calcium absorption due to the action of vitamin D?

The amount of absorbable calcium in the gut lumen is increased
Magnesium is displaced from calcium transport channels
Enterocyte ribosomal synthesis of calbindin is increased
The overall activity of enterocyte mitochondrial ATP production is stimulated

Enterocyte ribosomal synthesis of calbindin is increased

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The principal reason that magnesium is said to be involved in more metabolic reactions that any other element is

The requirement of Mg for membrane transporter action on several other elements
The requirement of Mg in reactions utilizing ATP
The fact that Mg is required for the action of zinc fingers
The use of the Mg-Lipoate complex in all oxidoreductase reactions

The requirement of Mg in reactions utilizing ATP

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Which phrase describes the first step in the assimilation of ingested dietary zinc?

Release of bound zinc from food complexes that are denatured by gastric acid
Transfer of ionic zinc to zinc fingers
Binding of free zinc to metal ion transporters in enterocyte brush borders
Metallothionein loading with zinc

Release of bound zinc from food complexes that are denatured by gastric acid

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A patient who has been on SSRI medications for 2-3 years is most likely to have a deficiency of which amino acid?

Phenylalanine
Glutamic acid
Gamma-aminobutyric acid
Tryptophan

Trp

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In the absence of any other laboratory evidence, finding a pattern of strongly elevated serene with low glycine on a plasma amino acid profile would suggest deficiency of which essential nutrient?

Thiamin
Vitamin D
5-Methyltetrahydrofolate
Vitamin C

5MTHF, used by serine n-methyltransferase to convert serine to glycine (also goes in reverse)

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S-Adenosylmethionine therapy is most likely to be helpful in cases where elevation of which amino acid is found? 3-Methylhistidine Taurine Phosphoethanolamine Hydroxylysine

Phosphoethanolamine (3 SAMe are needed to methylate phosphoethanolamine into phosphatidyl choline)

Choline is a derivative of which amino acid? Glutamate Glycine Glutathione Glutamine

Glycine

A patient who shows a pattern of low levels for threonine, glycine and serine is a candidate for what type of specific amino acid supplementation. Positively charged side chain Acid-yielding Branched-chain Glutathione precursor

Glutathione precursor...these are all sulfur containing AAs used to make GSH (threonine can be converted to glycine)

A patient with elevated levels of urinary alpha-aminoadipic acid due to an inherited metabolic disorder should avoid supplementation with which amino acid? Lysine Histidine Threonine Cysteine

Lysine is converted to aAAA via saccarophine dehydrogenase utilizing b3 as coenzyme

Hepatic activity of which pathway is responsible for the disposition of excess dietary tryptophan? ADMA BCKDC Gamma-glutamyl Kynurenin

Kynurenin

Which specific compound, appearing at elevated levels in plasma or urine, would best identify a patient who habitually consumes chicken or turkey almost every day? Xanthurenic acid Carnosine Pipecolic acid Anserine

Anserine (poultry)...carnosine is pork/beef

Elevated levels of which of the following fatty acids indicates general PUFA deficiency? Stearic acid Alpha linolenic acid Mead Oleic acid

Mead

Which of the following is the most abundant PUFA in the average American diet? GLA ALA Oleic Linoleic

Linoleic

A patient with biotin deficiency is likely to show elevated levels of which fatty acid? Nonadecanoic Lauric Myristoleic Lignoceric

Nonadecanoic...this is an odd chain FA. REmember that acetyl coA carboxylase is biotin dependent, and it converts acetyl CoA to Malonyl CoA to generate even numbered FAs. When it is downregulated, due to biotin deficiency, less malonyl CoA is formed and PROPIONATE is able to enter in greater amounts, and PROPIONATE is used to build ODD chains. NONADECONIC = 19 carbons

Which class of fatty acids can enter the beta-oxidation cycle without the involvement of the carnitine shuttle? Odd chain Very long chain Medium chain Long chain

Medium chain

Why does the level of arachidonic acid tend to fall in patients who take large doses of flax oil daily for many weeks? Biliary stimulation due to high unsaturated fatty acid intake Increased rates of peroxisomal arachidonic acid oxidation due to rising oleic acid levels Retarded desaturase activity due to accumulation of linoleic acid in cell membranes Competitive inhibition of omega-6 fatty acid binding to delta-6 desaturase enzymes

Competitive inhibition of omega-6 fatty acid binding to delta-6 desaturase enzymes

Why is DHA extremely slow to rise when infants are fed formulas supplemented with flax oil? The high tissue content of ALA slows the release of EPA by PLA2 enzymes The peroxisomal degradation step required to yield DHA is very slow and inefficient Flax oil stimulates the removal of DHA from cell membranes for eicosanoid synthesis Flax oil stimulates the removal of EPA from cell membranes for eicosanoid synthesis

The peroxisomal degradation step required to yield DHA is very slow and inefficient

Essential fatty acid deficiency results in rising levels of which fatty acid? Palmitoleic Hexacosanoic Linoleic Arachidonic

Palmitoleic

Which fatty acid ratio elevation is frequently found in patients who display inordinately strong responses to inflammatory stimuli? AA/EPA Stearic/Oleic LA/DGLA Triene/Tetraene

AA/EPA...AA is omega 6 and generates series 2 eicosanoids

Specific concern about a patient's calcium and vitamin D status would be especially confirmed by which test result? Low levels of plasma taurine and cystine Elevated erythrocyte saturated fatty acids Elevated plasma hydroxylysine and hydroxyproline Low levels of sarcosine and anserine

Elevated plasma hydroxylysine and hydroxyproline, suggesting high bone turnover

Which is used for baseline, non-challenged toxic element assessment? Whole blood RBCs Hair Urine

Whole blood

Hair is helpful in some cases because keratin is sulfur rich and some elements bind to the keratin. T/f

Due to sulfhydryl groups, hair concentrates toxic metals 10 fold above what is in blood. T/F

Urine does not vary with dietary intake, so is not helpful for assessing nutrient status. T/F

False, it does vary with intake

Serotonin is a precursor to melatonin, but SSRIs do not affect melatonin T/f

False, they do

PPIs affect: Calcium B12 Protein All

All

Long term SSRI use can lead to deficiency of Phenylalanine Tryptophan Glutamic acid GABA

Tryp

Which sulfur containing AAs are required for GSH creation? ``` Met Cys Ser Hcys All ```

All

High alpha-OH-butyrate, low sulfate, high pyroglutamate together indicate Need for B-vitamins Low glutathione status Low vitamin E Low vit K

Low GSH status

GPx (glutathione peroxidase) requires which 2 nutrients to reduce GSSG to GSH? B3 B2 Zn Se

Se, B2

A patient who shows a pattern of low levels for threonine, glycine and serine is a candidate for what type of specific amino acid supplementation. B6 Vit C Glutathione precursors Vit E

Gsh precursors

. Low sulfate suggest poor total-body glutathione status. T/F

What is the implication of LOW homocysteine for the likelihood of finding elevated alpha-hydroxybutyrate?

AHB would be high in late stage GSH depletion, due to the need for HCys to flow into L-cys formation, which is then turned into GSH

Neutrophil hypersegmentation is a sign of folate deficiency. T/F

True

Elevated levels of ucOC >20% total osteocalcin indicates a vitamin K deficiency T/F

True

PDC (Pyruvate dehydrogenase complex) converts pyruvate to acetyl-CoA during aerobic metabolism and is said to be the gatekeeper of acetate units to drive the citric acid cycle. Which cofactors does it need?

B1, B2, B3, B5, Lipoic acid

low ALA, EPA and DHA with normal or elevated AA Omega 3 deficiency Omega 6 deficiency General EFA deficiency

Omega 3

Low DGLA/EPA and low AA/EPA = Omega 3 deficiency Omega 6 deficiency General EFA deficiency

omega 6

Multiple low n’3 and n-6, high mead, high palmitoleic acid and high T:T ratio - Omega 3 deficiency Omega 6 deficiency General EFA deficiency

EFA deficiency

Triene/Tetraene (T:T ) ration is a ratio of Mead to Arachidonic acid T/F

fatty acids are categorized frequently according to chain length within each greater category or desaturation level or PUFA omega double bond position. T/F

What fatty acid is part of the structure of the most active endocannabinoids? Arachidonic Acid EPA ALA LA

Adrenoleukodystrophy is lack of ___________ activity required for oxidation and clearance of VLCFA. Those fatty acids accumulate massively, producing chronically progressive neuropathic symptoms in the patients. Carnitine shuttle Peroxisome PPAR Cortisol

Peroxisome

Counting the terminal methyl group, how many carbon atoms are present following the double bond most distant from the carboxylic acid in an omega-3 fatty acid? 1 2 4 3

key pancreatic enzyme catalyzing protein digestion thus measures proteolytic activity. Low levels call for digestive enzymes. Chymotrypsin Elastase Lipase

Chymotrypsin

Marker of exocrine pancreatic function Chymotrypsin Elastase Lipase

Elastase

Marker of neutrophil activity and inflammation. Produced in abundance at sites of inflammation, this biomarker has been proven clinically useful in differentiating between Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). Fecal sIgA EPX Calprotectin

Calprotectin

marker of eosinophil activity and inflammatory, allergic and parasitic influence Fecal sIgA EPX Calprotectin

EPX

marker of secretory immune function, GI mucosal defense, and the maintenance of gut barrier function. When increased, need to eliminate offending antigens. Fecal sIgA EPX Calprotectin

Fecal sIgA

most abundant SCFA in the colon. Shown to increase cholesterol synthesis. Acetate Propionate n-Butyrate

Acetate

shown to inhibit cholesterol synthesis. Acetate Propionate n-Butyrate

Propionate

plays a notable role for maintaining colonic health – a decrease in n-butyrate oxidation by colonic epithelial cells could be a factor in ulcerative colitis and colon cancer. When low, increase fiber. Acetate Propionate n-Butyrate

n-Butyrate

Heme synthesis pathway contains 8 enzymes and it begins/end in the mitochondria with 4 steps in the cytosol. T/F

true

Organotoxins and Arsenic both inhibit the last stage of UROD function in heme synthesis. T/f

False...beginning stages

The following elevations indicate which toxin affecting UROD? Uroporphyrins, Pentacarboxyporphyrin, Copro 1, high copro 1:3 ratio Arsenic Mercury Lead

Arsenic

The following elevations indicate which toxin affecting UROD? Aminolevulinic acid (ALA), Copro 3, Zn proto Arsenic Mercury Lead

Lead

The following elevations indicate which toxin affecting UROD? Precopro, pentacarboxy, total copro Arsenic Mercury Lead

Mercury

Polyvinylchloride, methyl chloride, polyborminated biphenyls cause which elevation? Coproporphyrins Uroporphyrins

Copro

Hexachlorobenzene and dioxin cause which elevation? Coproporphyrins Uroporphyrins

Uro

decreased production of T3 and T4 at the level of the thyroid gland; can be due to autoimmunity, low iodine intake, poor iodine uptake by the thyroid gland. Characterized by low or low-normal T4 and T3, with high TSH. Primary hypothyroidism Secondary Tertiary

Primary

inadequate stimulation of gland due to low TSH production from pituitary Primary hypothyroidism Secondary Tertiary

secondary

due to hypothalamic dysfunction, where low amt of TRH is released, leading to low TSH release and finally low thyroid hormone release Primary hypothyroidism Secondary Tertiary

tertiary

displays decreased T3 with normal TSH and T4, due to decreased conversion of T4 to T3 in peripheral tissue Primary hypothyroidism Secondary Tertiary Functional

Functional

High blood levels of fatty acids can inhibit the conversion of T4 to T3. T/F

Lipoic acid is shown to increase tissue use of thyroid hormone thereby decreasing the conversion of T4 to T3 T/F

Thyroid hormones stimulate synthesis of enzymes like the mitochondrial cytochrome-C T/F

High TSH has also been tied to high hemoglobin A1c. T/F

True

_______deficiency can impair parathyroid hormone and lower the responsiveness of osteoclasts to release calcium into circulation, thus it is helpful in correcting hypocalcemia. Calcium Magnesium Manganese Potassium

Magnesium

Calcium decreases the absorption of Magnesium Zinc Copper Potassion

Zinc

High ____ decreases magnesium absorption. Calcium Zinc Manganese Potassium

Zinc

Metabolic fragility – insufficiency of _______ and glutamate causes a difficulty to response to bodily shifts in pH and ammonia production Arginine Serine Glutamine Glutathione

Glutamine

What other enzyme is the principal cause of PKU? How is it involved in the clearance of excess L-phenylalanine?

GTP cyclohydrolase. It's involved in the formation of BH4, which is the required coenzyme for phenylalanine hydroxylase.

Pyruvate Dehydrogenase Complex has 3 subunits: E1, E2, E3. Which cofactor(s) relate to each subunit? ``` B1 B2 B3 B5 Lipoic ```

E1= B1 E2=B5 and lipoic E3=B2, B3

Regarding PDC, which is the nutrient it most strongly depends upon? ``` B1 B2 B3 B5 Lipoic ```