560I Function Nutr Quiz Questions Flashcards
Finding elevated urinary alpha-ketoisocaproate and alpha- ketoisovalerate is indication of what essential nutrient deficiency?
A - Coenzyme Q10
B - Vitamin B6
C - Vitamin D
D - Vitamin B1
Elevated urinary alpha-ketoisocaproate and alpha-ketoisovalerate indicates a B1 (thiamin) deficiency
When serum lipid peroxides are elevated, even though all serum antioxidant vitamins are in their upper normal ranges, what other abnormality is likely to be present?
High PUFAs in plasma
Could potentially be due to delta-6 desaturase deficiency caused by B6, Zn, and/or Mg deficiency??
Which compound is measured as a laboratory test for vitamin K deficiency?
Undercarboxylated osteocalcin
Assessment of vitamin D deficiency is done by measuring serum levels of what compound?
25-Hydroxyvitamin D
A patient can have normal serum vitamin B12, but still show elevated urinary methylmalonate because:
MMA metabolism requires INTRACELLULAR activity of B12, so this would indicate a functional deficiency
Which of the following is NOT a folate deficiency sign?
A - Urinary xanthurenic acid elevation
B - Plasma homocysteine elevation
C - Urinary FIGLU elevation
D - Neutrophyl hypersegmentation
A - urinary xanthurenic acid elevation
This is an indicator of B6 deficiency, not B9
Which vitamin insufficiencies are indicated by elevated branched chain keto acids in urine?
B-complex
Vitamin B6 deficiency causes elevated homocysteine by what mechanism?
A - Reducing the active form of B12
B - Impairing the conversion of homocysteine to cysteine
C - Accelerating the conversion of methionine to homocysteine
D - Blocking the transfer of methyl groups to THF
B – B6 deficiency impairs the conversion of homocysteine to cysteine
What does the abbreviation BH4 represent?
Tetrahydrobiopterin
Which of the following is NOT useful for assessing iron status?
A - Transferrin saturation
B - Total iron binding capacity (TIBC)
C - hair iron concentration
D - Serum ferritin
C - Hair iron concentration
A patient with chronic negative calcium balance would be expected to have elevated calcium in which specimen type:
A - Whole blood
B - Head Hair
C - Erythrocytes
D - Unchallenged 24hr urine
B - head hair
What organ failure most directly causes multiple low essential trace elements to be found in blood or urine?
Stomach - due to low HCl
A DMSA provocation test would usually be done to assess what problem?
A - Trace element loss due to renal retention deficit
B - Hypothyroidism due to iodine malabsorption
C - Toxic element exposure
D - Bone loss due to calcium deficiency
C - toxic element exposure
- measures toxic metal load in the body
When very low erythrocyte magnesium is found, the patient is likely to have what other type of insufficiency?
Glutathione
direct correlation between RBC Mg levels and GSH/GSSG concentration (circulating reduced/oxidized glutathione)
MgD was accompanied by a two-fold decrease in glutathione (GSH) concentration in RBCs [35]. In other types of cells, the overexpression of glutathione transferase has been suggested to be the cause of GSH depletion
Which of the following is NOT considered to b a highly toxic element?
A - Boron
B - Arsenic
C - Lead
D - Mercury
A - Boron
Which of the following is a good test for copper excess?
A - Low serum copper to ceruloplasmin ratio
B - Urinary HVA/VMA ratio
C - RBC Cu
D - Urinary copper
D - urinary copper
Which hormone suffers from reduced activity in a chromium deficiency?
Insulin
Why does the direct testing of calcium in body fluids fail to reveal nutritional status of calcium?
Strong mechanisms assure constant ionic calcium levels even in calcium deficiency
Which element has been shown to protect from the toxic effects from mercury?
Selenium
A pattern of elevated essential amino acids is an early sign of deficiency of what vitamin?
Vitamin B6
Which medical condition is often found in patients with elevated plasma asymmetric dimethylarginine (ADMA)?
ADMA levels are increased in people with hypercholesterolemia, atherosclerosis, HYPERTENSION, chronic heart failure, diabetes mellitus and chronic renal failure.
What metabolic process creates the largest demand for amino acids?
A - Hydrochloric acid production
B - Protein synthesis
C - Neurotransmitter synthesis
D - Hepatic detoxification reactions
B - protein synthesis
What effect does delayed specimen transport have on relative levels of glutamate and glutamine?
Glutamine is slowly hydrolyzed to glutamate
believe has to do with warming temperatures in delayed transit
Which amino acid, when administered as a challenge for testing status of a vitamin, helps to alleviate one of the effects of deficiency of the vitamin?
A - tryptophan
B - isoleucine
C - histidine
D - phenylalanine
Histidine - used in urinary FIGLU testing (folate) which is done after a histidine load
Which amino acid is converted into a neurotransmitter by two sequential hydroxylation reactions requiring BH4 as a cofactor?
Phenylalanine
– Phenylalanine is hydroxylated to tyrosine by the enzyme phenylalanine hydroxylase (PAH)
Which amino acid is a substrate for competing reactions that lead to either a compound that supplies a methyl group or to a compound that supplies protection from oxidative stress?
Homocysteine
Transmethylation and Transulfuration pathways
What is the principle metabolic outcome of the glycine cleavage system?
Generation of 5-10-methylene THF
If a plasma amino acid profile shows low levels of four essential amino acids and normal levels of the others, what intervention is generally indicated?
A customized mixture of ALL essential amino acids
The principal advantage of free form amino acid supplements over purified protein products is:
More rapid delivery of amino acids into peripheral blood
Which abnormality pattern, when found on a plasma fatty acid report indicates that a patient is in general fatty acid deficiency?
A - Low Mead and palmitic acids
B - Low omega-3 and omega-6 with elevated Mead acid
C - Elevated stearic/oleic ratio
D - Low ALA, EPA, DHA and high stearic acid
B - low omega-3, low omega-6, and elevated Mead indicates that a patient has a general fatty acid deficiency
Which abnormality pattern, when found on a plasma fatty acid report, indicates that a patient is in omega-3 FA deficiency?
A - High palmitic/palmitoleic ratio
B - Low stearic/oleic ratio
C - Low ALA and EPA
D - Low LA, DGLA, and AA
C - Low ALA and EPA indicates an omega-3 fatty acid deficiency
Which abnormality pattern, when found on a plasma fatty acid report, suggests that a patient may be hypertriglyceridemic?
ALL saturated and monounsaturated fatty acids are found in their 4th or 5th quintiles
Which abnormality pattern, when found on a plasma fatty acid report, indicates that a patient is exhibiting the metabolic syndrome?
A “greater than” sign in quintile positions of saturated fatty acids when they are arranged according to carbon-chain length
Which abnormality pattern, when found on a plasma fatty acid report, indicates that a patient has adrenoleukodystrophy?
Greatly elevated lignoceric and hexacosanoic acids with normal levels of other saturated fatty acids
Adrenoleukodystrophy, or ALD, is a deadly genetic disease that affects 1 in 18 000 people. It most severely affects boys and men. This brain disorder destroys myelin, the protective sheath that surrounds the brain’s neurons – the nerve cells that allow us to think and to control our muscles
Finding multiple odd-chain fatty acids in erythrocytes means that there is some process causing elevated levels of which compound?
Propionate.
With B12 deficiency, you would see an accumulation of propionate because you no longer have enough B12 for the conversion of propionate to succinate.
Elevations of odd-chain fatty acids are also linked to a biotin deficiency - in which acetyl-CoA’s conversion to malonyl-CoA is reduced and propionate is allowed to enter in greater amounts.
IS possible to also get increased propionate from high intakes of animal and dairy products, as well as significant gut dysbiosis.
Which fatty acid source is appropriate for treatment of a patient with ALA and EPA in their upper quintiles and with LA and GLA in their first deciles?
A - Fish oil
B - Flax oil
C - Corn oil
D - Primrose oil
D - Primrose oil (omega-6)
Borage oil is another source of omega-6
What is the common name of the fatty acid written as 20:4n6?
Arachadonic acid
What cellular organelles other than mitochondria are required for VLCFA degradation?
Peroxisomes
Which vitamin is necessary for stimulation of peroxisome proliferator-activated receptors (PPAR)?
Vitamin A (9-cis-retinoic acid)
PUFAs can also activate PPARs
Which (of the following) urinary organic acid becomes elevated as a result of carnitine deficiency?
Adipate
Which (of the following) urinary organic acid becomes elevated as a result of CoQ10 deficiency?
Succinate
Which (of the following) urinary organic acid becomes elevated as a direct result of thiamin deficiency?
Alpha-ketoisocaproate
Which (of the following) urinary organic acid becomes elevated as a direct result of vitamin B6 deficiency?
Xanthurenate
Which (of the following) urinary organic acid becomes elevated as a direct result of biotin deficience?
Beta-hydroxyisovalerate
Which (of the following) urinary organic acid becomes elevated as a direct result of folate deficiency?
Formimiminoglutamate (FIGLU)
Elevation of which (of the following) urinary organic acids indicates that a patient has increased turnover of epinephrine?
Vanilmandelate
Elevation of which (of the following) urinary organic acids indicates that a patient has increased turnover of serotonin?
5-Hydroxyindoleacetate (5-HIAA)
Elevation of which of the following urinary organic acids is produced in a patient with thiamin deficiency that slows the action of the branched-chain keto acid dehydrogenase complex (BCKDC)?
alpha-keto-beta-methylvalerate
Which of the following is a urinary organic acid that becomes elevated in a patient due to massive intestinal overgrowth of Lactobacillus acidophillus?
D-Lactate
Why is oral challenging with DMSA used prior to toxic element testing of urine?
To demonstrate metallothionein loading status
Which of the following toxicants is considered to be iatrogenic?
A - Acetaminophen
B - D-Lactic acid
C - Naphthalene
D - 5-Methylchrysene
A - Acetaminophen
Which type of organotoxin is famous for originating from soft plastic products?
Pthalates
What are urinary products of glutathione conjugation called?
Mercaptans
How does the stimulation of hepatic cytochrome P450 activity by compounds in cigarette smoke illustrate the hormesis model of toxicant effects?
Very low doses of a toxic compound can have favorable effects
Why would a high protein diet be ill-advised for the patient whose laboratory report indicates a pathological detoxifier pattern?
A - Methylation pathways would be overloaded
B - Pathological detoxifiers have difficulty with ammonia clearance
C - It would exacerbate the effects of low Phase II detoxification capacity
D - Phase I detoxification needs to be stimulated
C – It would exacerbate the effects of low Phase II detoxification capacity
Which of the following is the most common reason for finding elevated benzoic acid in urine?
Hepatic glycine conjugation capacity has been exceeded
What urinary porphyrin becomes uniquely elevated in urine due to mercury toxicity?
Precoproporphyrin
How does dietary fiber help control total estrogen exposure in premenopausal women?
Reduction of enterohepatic estrogen circulation
Ammonia detoxification is not described by Phase I and Phase II reactions because…
It does not require oxidation and conjugation for clearance
Which of the following agents acts to protect enzymes inside of the mitochondria from oxidative damage?
A - Ceruloplasmin
B - Catalase
C - Manganese superoxide dismutase
D - Zinc-copper superoxide dismutase
D - Manganese superoxide dismutase
Zinc-copper superoxide dismutase is located in the cytosol
Which amino acid is unusually high inside erythrocytes to afford oxidative stress protection?
Taurine
Which vitamin sits near the center of the cellular redox potential spectrum?
Vitamin C
Accumulation of which compound tends to produce reductive stress?
NADH
Which compound is sometimes used as a biomarker of total body protein oxidative damage?
Nitrotyrosine
Match the laboratory markers with their category of oxidative stress damage:
A - Isoprostanes
B - Methionine sulfoxide
C - 8-Hydroxy-2’-deoxyguanosine
D - 3-Nitrotyrosine
——————————————
DNA damage
Protein damage
Lipid damage
A - Isoprostanes – lipid damage
B - Methionine sulfoxide – protein damage
C - 8-Hydroxy-2’-deoxyguanosine – DNA damage
D - 3-Nitrotyrosine – protein damage
In a patient with multiple signs of oxidative stress, physiological forms of which TWO micronutrients are needed because they act in tandem directly upon glutathione to achieve the recycling of the oxidized to the reduced form?
alpha-lipoic acid (lipoate) and NADP+ (from nicotinamide)
These two will also regenerate the oxidized form of thioredoxin
What factor released during sleep adds strong protection against oxidative stress?
Melatonin
What antioxidant is specifically indicated to be under stress, leading to reduced antioxidant stress response capacity when a patient is found to have elevated pyroglutamate and alpha-hydroxybutyrate?
Glutathione
Which response shows the three trace elements that are required for the action of superoxide dismutase enxymes?
Zn, Cu, Mn
Production of which of the following cell regulators is directly affected by the deficiency of iodine?
A - Nitric oxide
B - Serotonin
C - Thyroxin
D - Corticosteroids
C - Thyroxin
Production of which of the following cell regulators is directly affected by deficiency of tryptophan?
A - Thyroxin
B - Nitric Oxide
C - Corticosteroids
D - Serotonin
D - Serotonin
Production of which of the following cell regulators is directly affected by a deficiency of arginine?
A - Nitric oxide
B - Serotonin
C - Thyroxin
D - Corticosteroids
A - Nitric Oxide
Production of which of the following cell regulators is directly affected by an excessive consumption of broccoli?
A - Thyroxin
B - Nitric Oxide
C - Corticosteroids
D - Serotonin
A - Thyroxin
Which of the following is a hormone that is NOT derived from cholesterol?
A - Estrone
B - Norepinephrine
C - Cortisol
D - Testosterone
B - norepinephrine
Which of the following test results is a marker for chronic stress response?
A - Low SIgA
B - High estradiol
C - Low insulin
D - High thyroxin
Low SIgA
Low SIgA levels generally reflects a depressed or exhausted immune system as a result of ongoing health imbalances. It is generally seen with adrenal fatigue, chronic infections, and the use of hydrocortisone and steroid medications.
What hormonal abnormality would be suspected in a patient with elevated serum triglycerides, elevated serum LDL cholesterol, obesity, and non-alcoholic liver disease?
A - Hyperthyroidemia
B - Low Cortisol
C - Hyperinsulinemia
D - Low estrogen
Hyperinsulinemia
Which of the following is used to asses risk of cancer from poor regulation of estrogen metabolism?
A - estradiol/estriol ratio
B - Estrone/estriol ratio
C - Pregnenalone/Testosterone ratio
D - 2/16 Hydroxyestrogen ratio
D - 2/16 Hydroxyestrogen ratio
Cytokine signaling pathways frequently use which type of chemical reaction to transmit and amplify signals?
Phosphorylation
The AKT signaling pathway is involved in the initiation of which cellular process?
Apoptosis
What information is conveyed by a rectangle with the left side green with a negative sign and the right sign red with a plus sign when on a laboratory SNP profile report?
One allele of the relevant gene was negative and the other one was positive for the relevant SNP
What kind of clinically relevant information is found at the website named OMMBID?
A - It is a site where taxonomic features are described
B - Metabolic defects are described for inherited diseases
C - OMMBID is a database of SNPs
D - Anatomic pathology features of chronic diseases are illustrated
Metabolic defects are described for inherited diseases
What advantage may be derived from the use of a patient’s genomic data when choosing drug therapies?
Dosages may be adjusted according to SNPs that affect their metabolism
The designation (A856G) conveys what information?
At base position 856 in the related gene, there is a single nucleotide polymorphism due to the replacement of adenosine by guanosine
A circle graph representing percentages of different CYPs – what does it illustrate in regards to genomics in drug metabolism?
No specific genetic information is shown, but rather the figure illustrates the diversity of cytochrome P450 isoenzymes, each of which may be affected by SNPs in an individual
Which of the following steps in gene expression can be altered by environmental factors?
A - DNA transcription
B - All of these are correct
C - RNA translation
D - Post-translational protein alterations
B - All of them are correct
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?
Low urinary vanilmandelic acid
Vanilmandelate comes from epinephrine, so with reduced conversion from dopamine, this would cause lower VMA levels
Which response describes the level at which microRNAs act to affect processes like the uptake of micronutrients such as iron?
A - preventing the formation of ribosomal RNA
B - alteration of gene expression rates
C - shifting gene products due to the presence of SNPs
D - Changing protein structures by modifying amino acid side chains
B – microRNAs alter gene expression rates
How is an enzyme’s activity altered by the presence of a homozygous SNP in the genes that express that enzyme?
A - There is no change in the rate of the catalyzed reaction
B - The rate of the catalyzed reaction is increased
C - The rate of the catalyzed reaction is decreased
D - Any one of these may apply to a given SNP
D - Any one of these may apply to a given SNP
