Final Flashcards
1
Q
What urinary porphyrin becomes uniquely elevated in urine due to mercury toxicity? A.) Precoproporphyrin B.) Uroporphyrin I & III C.) Coproporphyrin D.) Protoporphyrin
A
A
2
Q
Which of the following toxicants is considered to be iatrogenic? A.) 5-Methylchrysene B.) Acetaminophen C.) Naphthalene D.) D-Lactic acid
A
B
3
Q
How does the stimulation of hepatic cytochrome P450 activity by compounds in cigarette smoke illustrate the hormesis model of toxicant effects?
A.) All compounds in cigarette smoke are toxic at all concentrations
B.) Very low doses of a toxic compound can have favorable effects
C.) Cigarette smoke is only toxic under certain dietary conditions
D.) Cytochrome P450 creates non-toxic compounds from most compounds in cigarette smoke
A
B
4
Q
Why is oral challenging with DMSA used prior to toxic element testing of urine?
A.) To establish a baseline level before test specimen collection
B.) To normalize for hemoglobin in urine
C.) To demonstrate metallothionein loading status
D.) To increase instrumental sensitivity for mass spectrometric assay
A
C
5
Q
Which of the following agents acts to protect enzymes inside of the mitochondria from oxidative damage? A.) Zinc-copper superoxide dismutase B.) Manganese superoxide dismutase C.) Ceruloplasmin D.) Catalase
A
B
6
Q
What amino acid is unusually high inside erythrocytes to afford oxidative stress protection? A.) Taurine B.) Threonine C.) Thyroxin D.) Tyrosine
A
A
7
Q
Which vitamin sits near the center of the cellular redox potential spectrum? A.) Vitamin A B.) Pantothenic acid C.) Vitamin D D.) Vitamin C
A
D
8
Q
Accumulation of which compound tends to produce reductive stress? A.) BH4 B.) NADH C.) NAD D.) GSH
A
B
9
Q
Which compound is sometimes used as a biomarker of total body protein oxidative damage? A.) DNA strand breaks B.) Pyroglutamate C.) Uric acid D.) Nitrotyrosine
A
D
10
Q
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? A.) lysine and taurine
B.) EPA and DHEA
C.) folate and vitamin B12
D.) lipoate and nicotinamide
A
D
11
Q
What factor released during sleep adds strong protection against oxidative stress? A.) Melatonin B.) Prostaglandin E2 C.) Serotonin D.) IGF
A
A
12
Q
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? A.) Catalase B.) Trace elements C.) Tocopherols D.) Glutathione
A
D
13
Q
Which response shows the three trace elements that are required for the action of superoxide dismutase enzymes? A.) Fe, Mg, Zn B.) Co, Mo, Zn C.) Zn, Ca, Se D.) Cu, Zn, Mn
A
D
14
Q
Production of which of the following cell regulators is directly affected by deficiency of iodine? A.) Nitric oxide B.) Serotonin C.) Thyroxin D.) Corticosteroids
A
C
15
Q
Production of which of the following cell regulators is directly affected by deficiency of tryptophan? A.) Nitric oxide B.) Thyroxin C.) Serotonin D.) Corticosteroids
A
C
16
Q
Production of which of the following cell regulators is directly affected by deficiency of arginine? A.) Nitric oxide B.) Thyroxin C.) Serotonin D.) Corticosteroids
A
A
17
Q
Production of which of the following cell regulators is directly affected by excessive consumption of broccoli? A.) Thyroxine B.) Corticosteroids C.) Serotonin D.) Nitric oxide
A
A
18
Q
Which of the following is a hormone that is NOT derived from cholesterol? A.) Estrogen B.) Testosterone C.) Cortisol D.) Norepinephrine
A
D
19
Q
Which of the following test results is a marker for chronic stress response? A.) Low insulin B.) High estradiol C.) High thyroxin D.) Low sIgA
A
D
20
Q
What hormonal abnormality would be suspected in a patient with elevated serum triglycerides, elevated serum LDL cholesterol, obesity and non-alcoholic live disease? A.) Low cortisol B.) Low estrogen C.) Hyperthyroidemia D.) Hyperinsulinemia
A
D
21
Q
Which of the following is used to assess risk of cancer from poor regulation of estrogen metabolism? A.) Estradiol/Estriol ratio B.) Pregnenalone/Testosterone ratio C.) 2/16 Hydroxyestrogen ratio D.) Estrone/Estriol ratio
A
C
22
Q
Cytokine signaling pathways frequently use which type of chemical reaction to transmit and amplify signals? A.) Dipeptide formation B.) Glutathione reduction C.) Sulfation D.) Phosphorylation
A
D
23
Q
The AKT signaling pathway is involved in the initiation of which cellular process? A.) Mitosis B.) Apoptosis C.) Necrosis D.) Secretion
A
B
24
Q
Which of the following is true of a laboratory result that lies in the 5th quintile?
A.) Eighty percent or more of the reference population has values less that this result
B.) There are four quintiles above the value for this result.
C.) This result may be presumed to be within normal limits.
D.) According to standard clinical laboratory definitions, this result would necessarily be considered abnormal.
A
A
25
```
A patient with an elevated level of beta-hydroxyisovalerate in urine is a candidate for which nutrient addition?
A.) Biotin
B.) Vitamin B6
C.) Folic acid
D.) Lipoic acid
```
A
26
Serum concentrations of which of the following generally is considered to be the best compound for assessing vitamin D status?
A.) 25-Hydroxyvitamin D
B.) 1, 25-Dihydroxyvitamin D Ergosterol
C.) Ergocalciferol
A
27
Which of the following is a function NOT served by the single carbon pool?
A.) Delivery of reducing equivalents to form BH4
B.) Delivery of formyl groups to form purines
C.) Delivery of methylene groups to form pyrimidines
D.) Delivery of methyl groups to form SAMe
A
28
```
Which factor most commonly leads to multiple elevations of essential amino acids in fasting plasma?
A.) Vitamin B6 deficiency
B.) Vitamin K deficiency
C.) Chronic hypochlorhydria
D.) High protein diet
```
A
29
```
You would correctly recommend iron supplementation based on finding which abnormality in a patients record?
A.) Low serum ferritin
B.) Low hair iron
C.) High erythrocyte transferrin
D.) Low urinary iron
```
A
30
```
Finding very high levels of which element in erythrocytes would be of greatest concern regarding the recent appearance of toxic manifestations in a patient with a history of low urinary selenosugars?
A.) Mercury
B.) Cadmium
C.) Aluminum
D.) Lead
```
A
31
```
Metabolic impacts of some toxic elements are sensitively revealed by measuring intermediates in what pathway?
A.) Porphyrin synthesis
B.) Protein synthesis
C.) Bilirubin degradation
D.) Methionine catabolism
```
A
32
What test result might be used to justify intravenous chelation therapy?
A.) Elevated whole blood lead
B.) Low erythrocyte magnesium
C.) A high Phe/Tyr ration in plasma amino acids
D.) Multiple elevated keto-acids on a urinary organic acid profile
A
33
Which of the following describes the ultimate event that results in greater intestinal calcium absorption due to the action of vitamin D?
A.) Enterocyte ribosomal synthesis of calbindin is increased B.) Magnesium is displaced from calcium transport channels C.) The amount of absorbable calcium in the gut lumen is increased
D.) The overall activity of enterocyte mitochondrial ATP production is stimulated
A
34
Which phrase describes the first step in the assimilation of ingested dietary zinc?
A.) Release of bound zinc from food complexes that are denatured by gastric acid
B.) Binding of free zinc to metal ion transporters in enterocyte brush borders
C.) Transfer of ionic zinc to zinc fingers
D.) Metallothionein loading with zinc
A
35
```
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?
A.) 5-Methyltetrahydrofolate
B.) Thiamin
C.) Vitamin C
D.) Vitamin D
A.) 5-Methyltetrahydrofolate
S-Adenoxylmethionine therapy is most likely to be helpful in cases where elevation of which amino acid is found?
A.) Phosphoethanolamine
B.) Hydroxylysine
C.) 3-Methylhistidine
D.) Taurine
```
A
36
```
Elevated levels of which compound in plasma is predictive of clinical effects due to insufficient nitric oxide?
A.) ADMA
B.) SAMe
C.) NADPH
D.) ACTH
```
A
37
```
Elevated levels of which compound is associated with difficulty in conversion of ammonia to urea?
A.) All others shown
B.) Ornithine
C.) Citrulline
D.) Arginine
```
A
38
```
Which of the following is NOT a process that is dependent on the availability of arginine?
A.) Porphyrin synthesis
B.) Nitric oxide production
C.) Urea production
D.) Protein synthesis
```
A
39
Elevations of which of the following urinary organic acids indicates that a patient has increased turnover of epinephrine?
Vanilmandelate
40
```
Which of the following is a urinary organic acid that becomes elevated in a patient due to massive intestinal overgrowth of Lactobacillus acidophillus?
A.) D-Lactate
B.) D-Arabinitol
C.) L-Lactate
D.) D-Glucarate
```
A
41
```
Which of the following is a urinary organic acid that becomes elevated as a result of Coenzyme Q10 deficiency?
A.) Vanilmandelate
B.) Succinate
C.) Pyroglutamate
D.) D-Lactate
```
B
42
What are urinary products of glutathione conjugation called? \n\n\nGamma-glutamyl conjugates \nGlycine conjugates \nSulfated esters \nMercaptans
Mercaptans
43
How does dietary fiber help control total estrogen exposure in premenopausal women?
A.) Stimulation of cytochrome P450 hydroxylation
B.) Reduction of enterohepatic estrogen circulation
C.) Reduction of ovarian estrogen synthesis
D.) Stimulation if intestinal lipid absorption
B
44
Which of the following toxicants is considered to be iatrogenic?
```
Which of the following toxicants is considered to be iatrogenic?
A.) 5-Methylchrysene
B.) Acetaminophen
C.) Naphthalene
D.) D-Lactic acid
```
B
45
```
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?
A.) Alpha-keto-beta-methylvalerate
B.) Alpha-hydroxybutyrate
C.) Alpha
D.) 8-Hydroxy-2'-deoxyguanosine
```
A
46
```
Which type of organotoxin is famous for originating from soft plastic products?
A.) Phthalates
B.) Organophosphates
C.) Volatile solvents
D.) PCBs
```
A
47
Which of the following is the most common reason for finding elevated benzoic acid in urine?
A.) The liver is converting more toluene into benzoic acid.
B.) Hepatic coenzyme A levels are increasing.
C.) Pantothenic acid supplementation has been increased
D.) Hepatic glycine conjugation capacity has been exceeded.
D
48
Why is a low protein diet ill-advised for those who might be looking to “do a detox”?
Amino acid cofactors are needed for phase II detoxification
49
Ammonia detoxification is not described by Phase I and Phase II reactions because
A.) It does not require oxidation and conjugation for clearance.
B.) It requires only oxidation in order to be cleared.
c.) It is conjugated before it is oxidized for its major pathway of detoxification.
D.) Ammonia leaves the body primarily as exhaled gases.
A
50
When elevated this may be specifically indicative of a vitamin C deficiency
Hydroxyphenyllactate
51
```
Elevation of which of the following urinary organic acids indicates that a patient has increased turnover of serotonin?
A.) 2-Methylhippurate
B.) 5-Hydroxyindoleacetate
C.) 3,4-Dihydroxyphenylpropionate
D.) 8-Hydroxy-2'-deoxyguanosine
```
B
52
```
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?
A.) Alpha-keto-beta-methylvalerate
B.) Alpha-hydroxybutyrate
C.) Alpha
D.) 8-Hydroxy-2'-deoxyguanosine
```
A
53
```
Hepatic activity of which pathway is responsible for the disposition of excess dietary tryptophan?
A.) Kynurenin
B.) BCKDC
C.) ADMA
D.) Gamma-glutamyl
```
A
54
In order to rapidly offset acute increases in oxidative stress, homocysteine trans-methylation is inhibited while which pathway is stimulated?
A.) Homocysteine trans-sulfuration
B.) The SN1-SN2 transporter system
C.) Methylation of glycine to form sarcosine
D.) Phenylalanine conversion to tyrosine
A
55
```
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?
A.) Anserine
B.) Carnosine
C.) Xanthurenic acid
D.) Pipecolic acid
```
A
56
```
Elevated levels of which of the following fatty acids indicates general PUFA deficiency?
A.) Mead
B.) Alpha linolenic acid
C.) Stearic acid
D.) Oleic acid
```
A
57
```
Which of the following is the most abundant PUFA in the average American diet?
A.) Linoleic
B.) Oleic
C.) GLA
D.) ALA
```
A
58
```
A patient with biotin deficiency is likely to show elevated levels of which fatty acid?
A.) Nonadecanoic
B.) Lignoceric
C.) Myristoleic
D.) Lauric
```
A
59
```
A laboratory report that shows low levels of which fatty acid is of greatest concern regarding neurological development in a 2 year old child?
A.) DHA
B.) LA
C.) GLA
D.) AA
A.) DHA
What is the principal form of circulating fatty acids in the fasting state?
A.) LDL
B.) Chylomicrons
C.) HDL
D.) Free fatty acids
```
A
60
```
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?
A.) 1
B.) 2
C.) 3
D.) 4
```
B
61
```
Which class of fatty acids can enter the beta-oxidation cycle without the involvement of the carnitine shuttle?
A.) Medium chain
B.) Long chain
C.) Very long chain
D.) Odd chain
```
A
62
What is the physiological origin of the alkaline tide?
Stomach acid production
63
The Heidelberg capsule is a device that was developed for clinical assessment of what function?
Gastric acid output
64
Why is the flow of amino acids and vitamins from the gut to the liver not accompanied by dietary fatty acids?
Fatty acids are transferred into the lymphatic flow
65
What is the long-term major difference in prognosis between a positive IgE response and positive IgG4 response?
IgG4-reactive patients may resume eating reactive foods when the gut is healed
66
Which type of food-specific antibody is able to both block IgE responses and persist for many days a multi-antigen-binding complexes?
IGg4
67
```
A.) Phosphoethanolamine
S-Adenoxylmethionine therapy is most likely to be helpful in cases where elevation of which amino acid is found?
A.) Phosphoethanolamine
B.) Hydroxylysine
C.) 3-Methylhistidine
D.) Taurine
```
A
68
```
Choline is a derivative of which amino acid?
A.) Glycine
B.) Glutamine
C.) Glutamate
D.) Glutathione
```
A
69
In order to rapidly offset acute increases in oxidative stress, homocysteine trans-methylation is inhibited while which pathway is stimulated?
A.) Homocysteine trans-sulfuration
B.) The SN1-SN2 transporter system
C.) Methylation of glycine to form sarcosine
D.) Phenylalanine conversion to tyrosine
A
70
```
A patient with biotin deficiency is likely to show elevated levels of which fatty acid?
A.) Nonadecanoic
B.) Lignoceric
C.) Myristoleic
D.) Lauric
```
A
71
```
Which class of fatty acids can enter the beta-oxidation cycle without the involvement of the carnitine shuttle?
A.) Medium chain
B.) Long chain
C.) Very long chain
D.) Odd chain
```
A
72
```
Among reports in the medical literature, which is the most commonly used specimen for arsenic exposure screening?
A.) Urine
B.) Serum
C.) Whole blood
D.) Hair
```
A
73
```
Which specific nutrient supplementation is most directly indicated for a patient with greatly elevated urinary quinolinate and very low plasma tryptophan?
A.) Niacin
B.) Manganese
C.) Thiamin
D.) Vitamin D
```
A
74
```
When a patient's laboratory report shows very low zinc, what other abnormality takes on greatly added significance regarding need for clinical management?
A.) Elevated blood cadmium
B.) High erythrocyte magnesium
C.) Elevated urinary mercury
D.) Low stool predominant bacteria
```
A
75
```
If you had been monitoring a patient's urinary mercury levels monthly and notice a sudden increase, what kind of treatment procedure would be suspected as a major contributing factor?
A.) Dental amalgam removal
B.) Oral anti-fungal therapy
C.) Radiation for cancer
D.) Multiple weekly colonic therapy
```
A
76
```
If you were requested to prepare a one day DMSA dosing schedule for a patient, what laboratory profile would you expect to be ordered on that patient?
A.) Urine toxic elements
B.) Urine organic acids
C.) Plasma amino acids
D.) Whole blood volatile solvents
```
B
77
```
Which potential intervention for a patient would bereinforced by the following laboratory abnormalities? - low plasma homocysteine, low erythrocyte magnesium, high urinary 8-hydroxy-2'-deoxyguanosine, and low urinary sulfate.
A.) N-Acetylcysteine
B.) Omega-3 fatty acids
C.) Folic acid
D.) Vitamin C
```
A
78
```
Considering the precursor amino acid for thyroid hormone production, which laboratory abnormality would suggest a potential line of specific nutritional therapy for a patient with negative autoimmune thyroid antibodies and chronically low thyroid function that is unresponsive to aggressive supplementation of iodine?
A.) Very high plasma Phe/Tyr ratio
B.) Very high urinary HVA/VMA ratio
C.) Very high erythrocyte Zn/Cu ratio
D.) Very high serum 2/16 estrogen ratio
```
A
79
```
Which laboratory profile would you recommend to confirm suspicion of biotin deficiency?
A.) Urinary organic acids
B.) Erythrocyte trace elements
C.) Plasma amino acids
D.) Serum antioxidant markers
```
A
80
```
If you find mildly elevated urinary methylmalonic acid for a 10-year-old girl with idiopathic polyneuropathy, which laboratory profile would you recommend for confirmation of specific vitamin deficiency?
A.) Serum vitamin B12
B.) Serum folic acid
C.) Urinary beta-hydroxyisovalerate
D.) Urinary N-methylnicotinamide
```
A
81
```
Among the metabolic roles of zinc, which one involvesstructures called zinc fingers?
A.) Gene expression
B.) Cell membrane receptor binding
C.) Enzyme activation
D.) Insulin storage
```
A
82
```
Measuring levels of which serum protein can providedirect information about a patient's copper status?
A.) Ceruloplasmin
B.) Ferritin
C.) Albumin
D.) Prealbumin
```
A
83
```
A.) Erythrocyte
Use of which specimen for measuring potassium concentrationhas the strongest scientific support for assessing potassium deficiency?
A.) Erythrocyte
B.) Serum
C.) Hair
D.) Urine
```
A
84
```
Which urinary organic acid profile elevated result would be suspected to have been produced by finding that the patient had consumed a large serving of bananas and black walnuts with her evening meal before the overnight urine specimen collection for the test?
A.) 5-Hydroxyindoleacetate
B.) 8-Hydroxy-2'-deoxyguanosine
C.) Xanthurenate
D.) Tricarballylate
```
A
85
```
Dietary deficiency of which vitamin causes the situation known as the "Folate Trap?"
A.) Vitamin B12
B.) Vitamin B6
C.) Biotin
D.) Folate
```
A
86
```
Which component of biological membranes is most highly susceptible to hydroxyl radical attack?
A.) Polyunsaturated fatty acids
B.) Saturated fatty acids
C.) Cholesterol
D.) Steroid hormones
```
A
87
Why is a low protein diet I’ll advised for someone wanting to do a detox?
A. Methylation will be overlooked
B. Low protein diets make ammonia clearance more challenging
C. Amino acid cofactors are needed for phase 2 detox
C
88
What would be a cause of low vitamin A (retinol) levels?
1. ) Fat maldigestion
2. ) Retin A treatment for acne
3. ) Hypothyroidism
4. ) Supplementation
A
89
An iron deficiency can predispose someone to a toxicity of which element?
1. ) Cadmium
2. ) Arsenic
3. ) Mercury
4. ) Titanium
A
90
What would cause an iron deficiency secondary to poor absorption?
1. ) Hypochlorhydria
2. ) Menstruation
3. ) Lactation
4. ) GI Inflammation
4
91
Which organic acid would we expect to see elevated in a client who is currently taking a statin medication?
1. ) Hydroxymethylglutarate
2. ) Malate
3. ) Fumerate
4. ) Succinate
A
92
What amino acid will help correct the drop in plasma non-essential amino acids from injury?
1. ) Methionine
2. ) Leucine
3. ) Histidine
4. ) Glutamine
4
93
What is associated with a zinc deficiency?
1. ) High propionate and odd chain fatty acids
2. ) High LA/DGLA ratio
3. ) Low oleic and linoleic acid
4. ) High stearic and docasadienoic acid
2
94
Which of the following is a urinary organic acid that becomes elevated as a result of Co-enzyme Q10 deficiency?
1. ) Vanilmandelate
2. ) D-Lactate
3. ) Pyroglutamamte
4. ) Succinate
4
95
What would be the intervention if Citrate, Cis-Aconitate, and Isocitrate are all elevated?
1. ) CoQ10
2. ) B6
3. ) Balanced amino acid supplementation
4. ) Arginine
4
96
1.) IgA
Which immunoglobulin is the first line of defense in the gut epithelium?
1. ) IgA
2. ) IgE
3. ) IgG
4. ) IgM
1
97
Which heavy metal primarily affects the kidneys and lung?
1. ) Mercury
2. ) Cadmium
3. ) Aluminum
4. ) Lead
2
98
Which conjugation pathway in the liver is responsible for eliminating excess estrogens?
1. ) Sulfation
2. ) Glucuronidation
3. ) Gluathione
4. ) Glycine
2
99
Which of the following assessment of heavy metals is associated with a current exposure?
1. ) Urine provoked challenge
2. ) Hair
3. ) Blood
3
100
Which toxic element replaces calcium in bone?
1. ) Cadmium
2. ) Aluminum
3. ) Lead
4. ) Arsenic
2
101
A client's organic acid results come back and their vanilmandelate is low. You also see that on their plasma amino acid test tyrosine levels are normal. What nutrient are they most likely deficient in?
1. ) Copper
2. ) Zinc
3. ) Selenium
4. ) Iodine
1
102
Which of the following is a precursor to estrogen?
1. ) Estradiol
2. ) DHEA
3. ) 2-Hydroxyesterone
4. ) Estrone
2
103
Which is NOT one of the phase II conjugation pathways that detoxifies estrogen?
1. ) Methylation
2. ) Acetylation
3. ) Glucuronidation
4. ) Sulfation
2
104
Which laboratory finding tells you that a patient has an increased risk of kidney stone recurrence?
A.) Low urinary citrate
B.) Low urinary zinc
C.) Low urinary taurine
D.) Low urinary 25-hydroxycholecalciferol
A
