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Medicine 3 > GIM 1 > Flashcards

GIM 1 Flashcards

1
Q

What is nutrient flux?

A

The measure of activity of a metabolic pathway

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2
Q

What are the 3 metabolic pools?

A

Functional pool - direct involvement in body function

Storage pool - provides buffer

Precursor pool - provides substrate for nutrient synthesis

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3
Q

What is glycemic index?

A

The ranking of CHOs in food and how they affect blood glucose level (pure glucose GI = 100)

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4
Q

What the the recommendations for CHO intake?

A

~50% of dietary energy

Free sugar intake < 5% of calorie intake

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5
Q

What are the anaemia preventing vitamins?

A

B12 (animal products) and folate (green veg)

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6
Q

What are the sources of vitamin D?

A

D3 = fish oil, egg yolk, butter

7-dehydrocholesterol = animal fats, plant sterols, UV light

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7
Q

What is the physiologically active form of vitamin D?

A

Calcitriol (vit. D metabolised by liver and kidney hydroxylation)

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8
Q

What are the actions of vitamin D?

A

Intestinal and renal absorption of Ca and PO4

Normal bone formation

Neuromuscular and immune functions

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9
Q

What is caused by vitamin D deficiency?

A

Rickets (children)

Osteomalacia (adults)

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10
Q

What is the toxicity of vitamin D?

A

> 250micrograms/day

Leads to hypercalcaemia and calcification of soft tissues

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11
Q

What is the use of calcium?

A

Bones, cell signalling and muscle function

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12
Q

What are the sources of calcium?

A

Milk and dairy, flour, hard water

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13
Q

What is calbindin?

A

Intestinal Ca binding protein for Ca absorption (regulated by vit. D)

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14
Q

What is the metabolic response to low plasma Ca

A

Parathyroid hormone and vitamin D synthesis.

Vitamin D activated to calcitriol

Increased Ca absorption

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15
Q

What is the metabolic response to high plasma Ca

A

Calcitronin secreted from thyroid gland

Increased Ca excretion and prevention of Ca release from bones

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16
Q

What is the purpose of iron?

A

Hb and electron transport

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17
Q

Where is iron stored?

A

Reticulo-endothelial system and bone marrow

18
Q

What is transferrin?

A

A plasma transport protein that transfers iron to bone marrow

19
Q

In what form is iron absorbed?

A

Fe2+ (absorption enhanced by reducing agents)

20
Q

What are some examples of positive energy balance?

A

Obesity, growth, pregnancy, recovery

21
Q

What are some examples of negative energy balance?

A

Wasting disease, anorexia, starvation, voluntary weight loss

22
Q

What processes are involved in basal metabolic rate (BMR)

A

Heart and resp.
Protein turnover
Fat and CHO turnover
Ion gradient maintenance

23
Q

What is physical activity level (PAL)

A

Ratio of energy expenditure to BMR

24
Q

How do we assess nutritional status?

A 
Anthropometry (height, weight, BMI)
Body composition
Biochemistry and haematology 
Function
Dietary assessment
25
Q

What are the causes of undernutrition?

A

Increased nutrient demand

Reduced nutrient delivery to GI system

Inability for GI system to absorb nutrients

26
Q

What are the effects of undernutrition?

A 
Decreased insulin
Increased amino acid release (proteolysis)
Ketone bodies supply brain
Gluconeogenesis
Eventual protein and tissue breakdown
Fatty acids as energy source
27
Q

What are the different types of undernutrition?

A

Primary - diet related
Secondary - illness related
Specific - nutrient deficiency
Generalised - calorie deficiency

28
Q

What are the 2 types of protein-energy malnutrition (PEM)

A

Dry PEM - Marasmus (no oedema)
> severe calorie and protein deficiency

Wet PEM - Kwashiorkor (oedema)
> severe protein deficiency
> link to low [plasma albumin]

29
Q

What is refeeding syndrome?

A

A syndrome of metabolic disturbances resulting from re-nutrition to patients who are starved or severely undernourished

Patient re-nourished
Insulin increases and glucose moves into cells
Electrolytes (especially phosphate) move into cells for metabolism
Hypophastaemia results

31
Q

What is enteral nutrition support?

A

Small bowel feeding with pump administration. Results when patients are undernourished for 7 days

32
Q

What is parenteral nutrition support?

A

Administration of nutrients through central or peripheral vein. Used when GI tract not functional or accessible.

33
Q

What are the dietary risk factors of obesity?

A

Fat overconsumption
Excessive sugar intake
Alcohol - decreases fat oxidation and storage

34
Q

What is the main focus for obesity treatment/management?

A

Lifestyle modification

Limited drug therapies and bariatric surgery only used for severe obesity with co-morbidities

35
Q

For a patient with hypertension, what diet should they be put on?

A

DASH diet

36
Q

What are the benefits of a DASH diet?

A

High fruit and veg (lots of K+ reduces BP)
Reduced Na+ reduces BP
Evidence that diets high in Na+ and low in K+ result in hypertension

37
Q

What are the dietary benefits of non-starch polysaccharides?

A

Decrease LDL-C
Bind bile salts and prevent reuptake
High fibre - lower risk of CVD

38
Q

What are the functions of bile?

A

Digestion of fats and fat soluble vitamins

Secretion of waste products such as bilirubin

39
Q

How is bile made/secreted?

A

Secreted into canaliculi by hepatocytes
Modified by ductal epithelial cell secretions in bile ducts
Further modification in gallbladder (stored there in fasting state)

40
Q

What is the relationship between bile and cholesterol?

A

Cholesterol is synthesised in hepatocytes to make bile acids (cholate and chenodeoxycholate)

Cholesterol in diet is converted to bile acids

41
Q

How does bile aid lipolysis?

A

Bile salts emulsify lipids and break them down into little droplets - larger SA for easier digestion

42
Q

How does enterohepatic recirculation of bile work?

A

Venous blood travels from ileum to the liver through portal vein
Hepatocytes extract bile acids from sinusoidal blood
Re-secretion into canaliculi

43
Q

How do fish oils decease CVS risk?

A

Eicosapentaeonic acid (EPA) competes with arachidonic acid and reduces COX- to TXA3 instead of COX to TXA2. TXA3 has less platelet activating activity. Decreased risk of thrombosis by inhibited platelet aggregation

Medicine 3 (8 decks)

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