Lecture 24: Nutritional Metabolic Disorders

Question 1

Lead poisoning

Answer 1

Presents differently in children (behavioral/IQ problems) vs adults (ab pain, constipation, wrist drop, encephalopathy, unusual taste in mouth, hypochromic, microcytic anemia)

Question 2

Burton’s line

Answer 2

Discoloration of upper gum margin due to lead poisoning

Question 3

Mercury poisoning

Answer 3

Encephalopathy, sensorimotor neuropathy, seizures, tremor

Question 4

Arsenic and where it’s found

Answer 4

Encephalopathy, painful neuropathy, nausea, vomiting, diarrhea, renal failure, arrhythmias; warfare, murder, ground water

Question 5

Thallium and where it was and is found

Answer 5

Vomiting, diarrhea, paresthesias (small fiber neuropathy), cognitive impairment; rat poison (since banned), shellfish near coal burning plants

Question 6

Manganese and associated job

Answer 6

Psychiatric: confusion, irritability, compulsive behavior, then Parkinson’s disease symptoms BUT with increased reflexes (NOT like PD); associated with welders

Question 7

Forms of malnutrition (4)

Answer 7

1. Undernutrition; 2. Overnutrition; 3. Specific Deficiencies; 4. Imbalance

Question 8

Malnutrition can be due to…what’s one specific one in the US?

Answer 8

GI causes; bariatric surgery

Question 9

Marasmus

Answer 9

Balanced starvation often due to insufficient breast milk with wasting, mental changes, growth retardation

Question 10

Kwashiorkor

Answer 10

Low protein w/ enough carbohydrates; encephalopathy, muscle wasting

Question 11

Obesity specific definition

Answer 11

> 20% than desirable weight

Question 12

Pickwickian Syndrome. What are lab tests?

Answer 12

Complication of obesity w/ severe cardiorespiratory distress & alveolar hypoventilation; polycythemia, hypoxemia, cyanosis, CHF & somnolence

Question 13

Hypersomnia sleep apnea presents with…other effects?

Answer 13

Excessive daytime sleepiness; oxygen desaturation, arrhythmias

Question 14

Neurological complications of DM (6). All due to…

Answer 14

Dementia, ischemic cranial nerves, peripheral neuropatihies, plexopathies (plexes become involved), bilndness, increased risk of stroke; strokes of blood vessels to nerves

Question 15

Dietary excess: Vitamin A

Answer 15

Increased intracranial pressure

Question 16

Dietary excess: Water

Answer 16

Encephalopathy (water intoxication)

Question 17

Dietary excess: Protein

Answer 17

Hepatic encephalopathy

Question 18

Dietary excess: Pyridoxine

Answer 18

Peripheral neuropathy

Question 19

Dietary excess: Tryptophan (contaminated)

Answer 19

Neuropathy/myopathy

Question 20

Dietary excess: Emetine, ipecac

Answer 20

Myopathy (related to anorexia)

Question 21

What is the first step of alcohol withdrawal, followed by…

Answer 21

“Rum fits” (12-48 hours) –> DTs

Question 22

What optic nerve effect is related to alcoholism?

Answer 22

Amblyopia (degenerative)

Question 23

Serum alcohol levels and CNS toxicity

Answer 23

0.15 - 0.25 = slurred speech/ataxic gait, 0.3 = stupor, 0.4 = coma, 0.5 = death

Question 24

Cental pontine myelinolysis and cause

Answer 24

Demyelinated pons –> severe paralysis, dysphagia, dysarthria (death); alcoholism, over correction of hyponatremia

Question 25

Marchiafava-Bignami disease and cause

Answer 25

Demyelinated CC –> rapid psychosis, stupor, coma, death; alcoholism

Question 26

Alcoholic cerebellar degeneration

Answer 26

Truncal ataxia w/ midline problems

Question 27

Hepatic encephalopathy symptoms test

Answer 27

Dementia and ataxia; “Flapping tremor”

Question 28

Why might alcoholics get subdural hematoma

Answer 28

Shrinking brain (stretching of bridging veins)

Question 29

Thiamine deficiency: alcoholic vs pure

Answer 29

When due to alcohol, length dependent sensory or sensorimotor neuropathy;
pure thiamine deficiency polyneuropathy starts with weakness or numbness, rapid progression

Question 30

Wernicke’s encephalopathy triad and associated conditions

Answer 30

Ataxia, ophthalmoplegia, confusion; impaired absorption (various gastric disorders or bariatric surgery) or poor intake of thiamine (as in alcoholism), HIV, hyperemesis gravidarum

Question 31

Wernicke’s encephalopathy pathology

Answer 31

Lesions of medial thalamic nuclei, mammillary bodies, PAG, cerebellar vermis

Question 32

Korsakoff’s pathology

Answer 32

Neuronal loss/gliosis, hemorrhage into mammillary bodies, thalamus (DM, anterior group)

Question 33

How does Korsakoff’s develop? Presentation

Answer 33

Untreated Wernicke’s; memory loss (anterograde and retrograde) w/ confabulation, dementia, etc.

Question 34

Pyridoxine deficiency

Answer 34

Various types, often presents in infancy as seizures, necessitates Pyridoxine supplementation

Question 35

Cobalamine deficiency and other name

Answer 35

Can be related to diet (rare), congenital pernicious anemia, or NO abuse; combination of UMN and LMN problems due to demyelination, symptoms are symmetric and diffuse; subacute combined degernation of spinal cord

Question 36

Cobalamine deficiency can cause…(disease name) and test

Answer 36

Posterolateral column disease (UMN disease); Romberg test

Question 37

Vitamine E deficiency symptoms and causes

Answer 37

Progressive spinocerebellar syndrome and peripheral neuropathy w/ dry hair, baldness, muscle weakness, leg cramps; GI, pancreatic, hepatic disease