560I Functional Med - Quizes Flashcards
Finding elevated urinary alpha-ketoisocaproate and alpha-ketoisovalerate is an indication of what essential nutrient deficiency? Vitamin B1 Vitamin D Coenzyme Q10 Vitamin B6
Vitamin B1
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 vitamin D
Low polyunsaturated fatty acids in plasma
High polyunsaturated fatty acids in plasma
Low biotin
High polyunsaturated fatty acids in plasma
Which compound is measured as a laboratory test for vitamin K deficiency? Undercarboxylated osteocalcin 7-Dehydrocholesterol Sepiapterin Dehydroascorbic acid
Undercarboxylated osteocalcin
Assessment of vitamin D deficiency is done by measuring serum levels of what compound? Previtamin D3 25-Hydroxyvitamin D 1,25-Dihydroxyvitamin D Calcitriol
25-Hydroxyvitamin D
A patient can have normal serum vitamin B12, but still show elevated urinary methylmalonate because
• Methylmalonate causes anemia from folic acid deficiency.
• Methylmalonate metabolism requires intra-cellular activity of vitamin B12.
• Vitamin B12 promotes the formation of methylmalonate.
• The folate trap prevents proper methylation.
Methylmalonate metabolism requires intra-cellular activity of vitamin B12.
Which of the following is NOT a folate deficiency sign? Urinary xanthurenic acid elevation Urinary formiminoglutamate elevation Plasma homocysteine elevation Neutrophyl hypersegmentation
Urinary xanthurenic acid elevation
Which vitamin insufficiencies are indicated by elevated branched chain keto acids in urine? B-complex Cholecalciferols Antioxidants Ascorbates
B-complex
Why is it incorrect to speak of a “folic acid” deficiency?
Human tissues can synthesize folic acid
Folic acid is not an essential nutrient
Folic acid is highly toxic
Folic acid is not related to tetrahydrofolate
Folic acid is not an essential nutrient
Vitamin B6 deficiency causes elevated homocysteine by what mechanism?
• Reducing the active form of vitamin B12
• Accelerating the conversion of methionine to homocysteine
• Impairing the conversion of homocysteine to cysteine
• Blocking the transfer of methyl groups to THF
Impairing the conversion of homocysteine to cysteine
What does the abbreviation BH4 represent?
Tetrahydrobiopterin
A catabolic product of vitamin B6
A test for B-complex vitamin deficiency
A part of vitamin B12 structure
Tetrahydrobiopterin
A pattern of elevated essential amino acids is an early sign of deficiency of what vitamin? B6 C A B12
B6
Which medical condition is often found in patients with elevated plasma asymmetric dimethylarginine? Maldigestion Food allergies Chronic fatigue Hypertension
???
Hypertension
What metabolic process creates the largest demand for amino acids? Hepatic detoxification reactions Neurotransmitter synthesis Protein synthesis Hydrochloric acid production
Protein synthesis
What effect does delayed specimen transport have on relative levels of glutamate and glutamine?
• Glutamine is consumed by enzymes in plasma
• Glutamate decreases due to changes in pH
• The levels are stable for at least one week.
• Glutamine is slowly hydrolyzed to glutamate
Glutamine is slowly hydrolyzed to glutamate
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? Isoleucine Histidine Phenylalanine Tryptophan
Histidine
Which amino acid is converted into a neurotransmitter by two sequential hydroxylation reactions requiring tetrahydrobiopterin as a cofactor? Valine Glutamic Acid Phenylalanine Tryptophan
Phenylalanine
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? Proline Taurine Asparagine Homocysteine
Homocysteine
What is the principal metabolic outcome of the glycine cleavage system?
Generation of 5-10-methylene THF
Conversion of glycine to an important neurotransmitter
Initiation of the pathway that leads to heme formation
Regeneration of tetrahydrobiopterin
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 combination of antioxidants and the trace elements Zn, Cu and Mn
• A customized mixture of all essential amino acids
• Supplementation of the amino acids that are low at about twice their RDA levels
• A high fiber diet to reduce intestinal transit time
A customized mixture of all essential amino acids
The principal advantage of free form amino acid supplements over purified protein products is
• Lower risk of producing nitrogen overload
• Lower risk of gall bladder attacks due to release of cholegogues
• More rapid delivery of amino acids into peripheral blood
• Greater penetration into distal regions of the gut lumen
More rapid delivery of amino acids into peripheral blood
Which of the following is NOT useful for assessing iron status? • Total iron binding capacity • Transferrin saturation • Hair iron concentration • Serum ferritin
Hair iron concentration
A patient with chronic negative calcium balance is expected to have elevated calcium in which specimen type? • Erythrocytes • Whole blood • Head hair • Unchallenged 24 hr urine
Head hair
What organ failure most directly causes multiple low essential trace elements to be found in blood or urine? • Pancreas • Liver • Kidney • Stomach
Stomach
A DMSA provocation test would usually be done to assess what problem?
• Hypothyroidism due to iodine malabsorption
• Bone loss due to calcium deficiency
• Trace element loss due to renal retention deficit
• Toxic element exposure
Toxic element exposure
When very low erythrocyte magnesium is found, the patient is likely to have what other type of insufficiency? • Iron • Selenium • Vitamin C • Glutathione
Glutathione
Which of the following is not considered to be a highly toxic element? • Lead • Boron • Arsenic • Mercury
Boron
Which of the following is a good test for copper excess?
• Urinary copper
• RBC Cu
• Low serum copper to ceruloplasmin ratio
• Urinary HVA/VMA ratio
Urinary copper
The action of what hormone is reduced in chromium deficiency? • Thyroxine • Testosterone • Glucagon • Insulin
Insulin
Why does 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.
• Calcium levels in body fluids change too rapidly to allow interpretation of calcium balance.
• Other elements interfere with the measurement of calcium in body fluids.
• Calcium is present at levels too low to detect in body fluids.
Strong mechanisms assure constant ionic calcium levels even in calcium deficiency.
What element has been shown to protect from the toxic effects of mercury? • Copper • Zinc • Magnesium • Selenium
Selenium
Which abnormality pattern, when found on a plasma fatty acid report, indicates that a patient is in general essential fatty acid deficiency?
• Low Mead and palmitic acids
• Low omega 3 and omega 6 with elevated Mead acid
• Elevated stearic/oleic ratio
• Low ALA, EPA, DHA and high stearic acid
Low omega 3 and omega 6 with elevated Mead acid
Which abnormality pattern, when found on a plasma fatty acid report, indicates that a patient is in omega-3 fatty acid deficiency? • Low LA, DGLA and AA • High palmitic/palmitoleic ratio • Low ALA and EPA • Low stearic/oleic ratio
Low ALA and EPA
Which abnormality pattern, when found on a plasma fatty acid report, indicates that a patient is exhibiting the metabolic syndrome?
• A “less than” sign in the quintile positions of the saturated fatty acids when they are arranged according to chain length
• A “greater than” sign in quintile positions of the saturated fatty acids when they are arranged according to chain length
• Generally high monounsaturated all fatty acids with chain lengths of less than 20 carbons
• Generally low monounsaturated fatty acids and a high LA/GLA ratio
A “greater than” sign in quintile positions of the saturated fatty acids when they are arranged according to chain length
Which abnormality pattern, when found on a plasma fatty acid report, suggests that a patient may be hypertriglyceridemic?
• All saturated and monounsaturated fatty acids found in their 4th or 5th quintiles
• An elevated triene/tetraene ratio
• A low triene/tetraene ratio
• Low levels for all omega-3 and omega-6 fatty acids
All saturated and monounsaturated fatty acids found in their 4th or 5th quintiles
Which abnormality pattern, when found on a plasma fatty acid report, indicates a patient has adrenoleukodystrophy?
• Greatly elevated capric and lauric acids with normal levels of other saturated fatty acids
• Very low levels of monounsaturated fatty acids with gradually increasing levels of saturated fatty acids as chain length decreases.
• Simultaneous very high Mead, palmitoleic, and vaccenic acids with normal levels of myristoleic and erucic acids
• Greatly elevated lignoceric and hexacosanoic acids with normal levels of other saturated fatty acids
Greatly elevated lignoceric and hexacosanoic acids with normal levels of other saturated fatty acids
Finding multiple odd-chain fatty acids in erythrocytes means that there is some process causing elevated levels of which compound? • Stearate • Erucate • Fumarate • Propionate
Propionate
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? • Fish oil • Corn oil • Flax oil • Primrose oil
Primrose oil
What is the common name for the fatty acid written as 20:4n6? • Arachidonic acid • EPA • Linoleic acid • GLA
I think: Arachidonic acid
not Linoleic acid
What cellular organelles other than mitochondria are required for VLCFA degradation? • Smooth endoplasmic reticulum • Rough endoplasmic reticulum • Peroxisomes • Liposomes
Peroxisomes
Which vitamin is necessary for stimulation of PPAR? • Niacin • Folic acid • Vitamin A • Riboflavin
Vitamin A
Which of the following is a urinary organic acid that becomes elevated as a direct result of carnitine deficiency? • Orotate • Citrate • Adipate • Kynurenate
Adipate
Which of the following is a urinary organic acid that becomes elevated as a result of Coenzyme Q10 deficiency? • Succinate • Vanilmandelate • D-Lactate • Pyroglutamate
Succinate
Which of the following is a urinary organic acid that becomes elevated as a direct result of thiamin deficiency? • Glucarate • Formiminoglutamate • Alpha-ketoisocaproate • Phenylpropionate
Alpha-ketoisocaproate
Which of the following is a urinary organic acid that becomes elevated as a direct result of vitamin B6 deficiency? • Xanthurenate • Methylmalonate • Beta-hydroxyisovalerate • Fumarate
Xanthurenate
Which of the following is a urinary organic acid that becomes elevated as a direct result of biotin deficiency? • Alpha keto-B-methylvalerate • Alpha ketoisovalerate • Alpha Ketoglutarate • Beta-hydroxyisovalerate
Beta-hydroxyisovalerate
Which of the following is a urinary organic acid that becomes elevated as a direct result of folic acid deficiency? • Formiminoglutamate • Homogentisate • Hydroxymethylglutarate • Ethylmalonate
Formiminoglutamate
Elevation of which of the following urinary organic acids indicates that a patient has increased turnover of epinephrine? • Vanilmandelate • Homovanillate • Hippurate • Kynurenate
Vanilmandelate
Elevation of which of the following urinary organic acids indicates that a patient has increased turnover of serotonin? • 3,4-Dihydroxyphenylpropionate • 2-Methylhippurate • 8-Hydroxy-2’-deoxyguanosine • 5-Hydroxyindoleacetate
5-Hydroxyindoleacetate
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? • 8-Hydroxy-2’-deoxyguanosine • Alpha-hydroxybutyrate • Alpha • Alpha-keto-beta-methylvalerate
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? • L-Lactate • D-Arabinitol • D-Glucarate • D-Lactate
D-Lactate
Which of the following agents acts to protect enzymes inside of the mitochondria from oxidative damage? • Catalase • Zinc-copper superoxide dismutase • Ceruloplasmin • Manganese superoxide dismutase
Manganese superoxide dismutase
What amino acid is unusually high inside erythrocytes to afford oxidative stress protection? • Thyroxin • Taurine • Tyrosine • Threonine
Taurine
Which vitamin sits near the center of the cellular redox potential spectrum? • Pantothenic acid • Vitamin A • Vitamin D • Vitamin C
Vitamin C
Accumulation of which compound tends to produce reductive stress? • NAD+ • GSH • NADH • BH4
i think: GSH
not NAD+
Which compound is sometimes used as a biomarker of total body protein oxidative damage? • Uric acid • Nitrotyrosine • DNA strand breaks • Pyroglutamate
Nitrotyrosine
_____ is the laboratory marker for oxidative stress damage: lipid damage
Methionine sulfoxide
8-Hydroxy-2’-deoxyguanosine
Isoprostanes
3-Nitrotyrosine
Isoprostanes
\_\_\_\_\_ is the laboratory marker for oxidative stress damage(2): Protein damage Methionine sulfoxide 8-Hydroxy-2’-deoxyguanosine Isoprostanes 3-Nitrotyrosine
Methionine sulfoxide
3-Nitrotyrosine
\_\_\_\_\_ is the laboratory marker for oxidative stress damage: DNA damage Methionine sulfoxide 8-Hydroxy-2’-deoxyguanosine Isoprostanes 3-Nitrotyrosine
8-Hydroxy-2’-deoxyguanosine
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? • lysine and taurine • EPA and DHEA • lipoate and nicotinamide • folate and vitamin B12
lipoate and nicotinamide
What factor released during sleep adds strong protection against oxidative stress? • Melatonin • Serotonin • Prostaglandin E2 • IGF
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? • Trace elements • Catalase • Tocopherols • Glutathione
Glutathione
Which response shows the three trace elements that are required for the action of superoxide dismutase enzymes? • Co, Mo, Zn • Cu, Zn, Mn • Fe, Mg, Zn • Zn, Ca, Se
Cu, Zn, Mn
Production of which of the following cell regulators is directly affected by deficiency of iodine? • Nitric oxide • Thyroxin • Corticosteroids • Serotonin
Thyroxin
Production of which of the following cell regulators is directly affected by deficiency of tryptophan? • Thyroxin • Serotonin • Corticosteroids • Nitric oxide
Serotonin
Production of which of the following cell regulators is directly affected by deficiency of arginine? • Corticosteroids • Nitric oxide • Serotonin • Thyroxin
Nitric oxide
Production of which of the following cell regulators is directly affected by excessive consumption of broccoli? • Nitric oxide • Serotonin • Corticosteroids • Thyroxin
Thyroxin
Which of the following is a hormone that is NOT derived from cholesterol? • Testosterone • Cortisol • Estrone • Norepinephrine
Norepinephrine
Which of the following test results is a marker for chronic stress response? • High thyroxin • Low sIgA • High estradiol • Low insulin
Low sIgA
What hormonal abnormality would be suspected in a patient with elevated serum triglycerides, elevated serum LDL cholesterol, obesity and non-alcoholic live disease? • Hyperinsulinemia • Hyperthyroidemia • Low cortisol • Low estrogen
Hyperinsulinemia
Which of the following is used to assess risk of cancer from poor regulation of estrogen metabolism? • Pregnenalone/Testosterone ratio • Estradiol/Estriol ratio • 2/16 Hydroxyestrogen ratio • Estrone/Estriol ratio
2/16 Hydroxyestrogen ratio
Cytokine signaling pathways frequently use which type of chemical reaction to transmit and amplify signals? • Phosphorylation • Sulfation • Dipeptide formation • Glutathione reduction
Phosphorylation
The AKT signaling pathway is involved in the initiation of which cellular process? • Apoptosis • Necrosis • Mitosis • Secretion
Apoptosis
