8. Nutrition

Question 1

What’s the big difference between anorexia and bulimia?

Answer 1

Body image extremely distorted in anorexia - 60 lb woman

Bulimia - binges

Question 2

Why do people with anorexia and bulimia have amenorrhea?

Answer 2

Decreased GnRH

Question 3

What do people with anorexia die of?

Answer 3

Cardiac problems

Question 4

What acid base disturbance do you get with vomiting?

Answer 4

Metabolic alkalosis

Question 5

What major esophageal complication are bulimics at risk of?

Answer 5

Boeerhave syndrome (+ Mallory Weiss)

Question 6

What BMI means obese?

Answer 6

> 30

Question 7

What is the main complication of obesity?

Answer 7

Hypertension, left ventricular hypertrophy, potential risk of heart failure

Question 8

What kinds of cancer does obesity predispose you to?

Answer 8

Estrogen cancers because adipocytes increase aromatic activity - e.g. breast cancer

Question 9

What’s the major function of water soluble vitamins?

Answer 9

Cofactors

Question 10

What does Vitamin A deficiency look like?

Answer 10

Night blindness, failure to thrive, squamous metaplasia (particularly white spots in the cornea)

Question 11

Big game hunter who eats bear liver with headaches?

Answer 11

Hypervitaminosis A (cerebral edema and liver)

Question 12

What is the most common source of vitamin D?

Answer 12

Sunlight

Question 13

Is there vitamin D in breast milk?

Answer 13

No - that’s why babies need to be exposed to sunlight

Question 14

Where is vitamin D absorbed in the gut?

Answer 14

Jejunum

Question 15

Where is 1 alpha hydroxylase synthesized?

Answer 15

PCT (stimulated by PTH)

Question 16

What does vitamin D do?

Answer 16

Increase absorption of calcium and phosphate

Question 17

Why do thiazides have a risk of hypercalcemia?

Answer 17

Na and Ca take turns in the DCT but thiazides block reabsorption of Na so Ca is more able to be reabsorbed

Question 18

What is the only hormone that has a receptor on an osteoclast?

Answer 18

Calcitonin

Question 19

Where is PTH’s receptor?

Answer 19

Osteoblast

Question 20

When PTH binds to osteoblast what does it release?

Answer 20

IL-1 also called osteoclast stimulating factor

Question 21

How do cytochrome p450 inducers/inhibitors affect calcium levels?

Answer 21

Inducers (e.g. phenytoin, chronic alcohol) cause increased metabolism of vitamin D so it leads to hypocalcemia

Question 22

What is the enzyme of the smooth ER (marker of revved up cyp450)?

Answer 22

Gamma glutamyl transferase

Question 23

What is the most common cause of vitamin D deficiency?

Answer 23

Renal disease (e.g. from diabetes mellitus)

Question 24

What’s the most common complication of hypervitaminosis D?

Answer 24

Hypercalcemia –> Calcium stones

Question 25

What is Vitamin E’s main function?

Answer 25

1. Maintain cell membranes - prevent membrane peroxidation

2. Neutralizes oxidized LDL (cardio protective)

Question 26

What are the complications of Vitamin E deficiency?

Answer 26

Neurologic symptoms (demyelination of dorsal columns) and hemolytic anemia (membrane damage)

Question 27

What does Vitamin E toxicity look like?

Answer 27

Makes someone anticoagulable (prevents synthesis of K dependent factors)

Question 28

Where does most of Vitamin K come from?

Answer 28

Made by colonic bacteria (some comes from diet but most is made in the GI)

Question 29

What enzyme activates vitamin K?

Answer 29

Epoxide reductase

Question 30

What does vitamin K do?

Answer 30

Gamma carboxylation of coagulation factors - allows calcium to bind to these factors so that they can form a clot (basically form an anchor point)?

Question 31

What does warfarin do?

Answer 31

Block epoxide reductase

Question 32

What’s the most common cause of vitamin K deficiency in the hospital?

Answer 32

Broad spectrum antibiotics - wipe out GI bacteria

Question 33

Rat poison is what?

Answer 33

Warfarin