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CNSC Exam > Micronutrients > Flashcards

Micronutrients Flashcards

1
Q

populations at risk for vitamin D deficiency

A

fat malabsorption, pancreatic insufficiency, decreased bile acid secretion, decreased intestinal surface area

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2
Q

the first part of the body to show micronutrient deficiencies

A

oral cavity

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3
Q

the first sign/symptom to detect a micronutrient deficiency

A

serum labs

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4
Q

B12 and Copper deficiency are identical, the distinguishing factor is

A

B12 is macrocytic and Copper is hypochromic

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5
Q

Non-B complex vitamins (water soluble)

A

B vitamins, ascorbic acid, choline

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6
Q

micronutrients absorbed primarily in the stomach

A

Intrinsic factor, alcohol, copper, molybednum

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7
Q

micronutrients primarily absorbed in the duodenum

A

iron, selenium, calcium, phosphorous, magnesium, copper, thiamine, riboflavin, niacin, folate, A,D,E,K

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8
Q

micronutrients primarily absorbed in the jejunum

A

pantothenate, vitamin B6, zinc, chromium, manganese, , thiamine, riboflavin, vitamin C, iron, magnesium, ADEK, calcium, phosphorous

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9
Q

micronutrients are primarily absorbed in the ileum

A

B12, bile salts/acids, magnesium, vitamin C, D and K

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10
Q

micronutrients absorbed in the large intestine

A

vitamin K and biotin

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11
Q

major micronutrients deficient in roux-en-y gastric bypass

A

iron, calcium, intrinsic factor, b12, copper, fluoride, vitamin D, bile salts and thiamine

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12
Q

most likely micronutrient deficiency with an ileal resection <100cm of terminal ileum left over

A

B12, sodium, bile salts/acids limiting fat absorption, limited fat soluble vitamins

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13
Q

micronutrient losses associated with loss of terminal ileum

A

B12, Bile salts, fat malabsorption, fat soluble vitamin malabsorption, decreased essential fatty acid absorption, gastric hypersecretion and SIBO B12 deficiency

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14
Q

if the colon is intact, bacteria can produce _____ ,____,____, and ___in the setting of a lost ileum

A

thiamine, riboflavin, pantothenic acid, vitamin K

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15
Q

is there any evidence to support vitamin A supplementation in wounds

A

No

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16
Q

deficiency of vitamin ___ can delay wound healing as scar tissue wouldn’t be able to form from collagen

A

vitamin C

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17
Q

role of vitamin E for wound healing

A

an antioxidant used in collagen synthesis

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18
Q

is vitamin E beneficial in wound healing

A

YES

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19
Q

this micronutrient is involved in cell replication and growth, a co-factor for collagen, protein synthesis and proliferation of epithelial cells

A

zinc

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20
Q

why is measuring plasma zinc not the best indicator of zinc status

A

low serum zinc is widely distributed in body proteins which are decreased during inflammation

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21
Q

populations at risk for zinc deficiency

A

poor oral intake, diarrhea, large wounds, vegan diet

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22
Q

high doses of zinc interferes with ____ absorption

A

copper

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23
Q

symptoms of zinc deficiency

A

mouth ulcers, white spots on fingernails

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24
Q

when is supplementing with a multivitamin indicated in patients with pressure injuries

A

when po intake is poor AND deficiency is suspected from symptoms or confirmed with labs

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25
Q

micronutrient deficiencies indicated by scaling around the nostrils

A

B12, B6, zinc, niacin

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26
Q

petechia (hemorrhagic spots) can indicate ____ deficiency

A

vitamin C or K deficiency

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27
Q

pellagrous dermatitis (hyperpigmentation of the skin in areas exposed to the sun) can indicate

A

niacin deficiency

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28
Q

populations at risk for EFAD

A

long term TPN without lipids, fat malabsorption, PN dependence with an egg allergy, extremely low fat diet from chyle leak, impaired pancreatic enzyme secretion , diseased small bowel

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29
Q

xerosis (abnormal skin dryness) could indicate

A

vitamin A deficiency or essential fatty acid deficiency

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30
Q

follicular hyperkeratosis (plaques around the hair follicle) can indicate

A

Vitamin A, C and essential fatty acid deficiency

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31
Q

dermatitis can indicate

A

zinc and EFA deficiency

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32
Q

dull rough hair that is easily plucked, discolored and mis distributed with poor texture or hair loss can indicate

A

zinc deficiency, EFA deficiency, biotin deficiency

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33
Q

bitot spots (greyish, raised granulations on the conjunctiva of the eye) can indicate

A

vitamin A deficiency

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34
Q

loss of night vision can indicate

A

vitamin A deficiency

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35
Q

thiamine deficiency can lead to _____acidosis

A

lactic

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36
Q

mechanism of thiamine deficiency leading to lactic acidosis

A

thiamine is depleted 2/2 impaired absorption and poor po intake. Thiamine is the co factor for carbohydrate metabolism in glycolysis and the krebs cycle. Low thiamine prevents pyruvate dehydrogenase from changing pyruvate into acetyl coA leading to a buildup of lactate (cori cycle) leading to severe lactic acidosis

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37
Q

symptoms of Wernicke’s Encephalopathy

A

confusion, poor muscle coordination, abnormal eye movements (aterexis)

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38
Q

vitamins that affect the oral cavity

A

b vitamins

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39
Q

bilateral fissures (angular stomatitis) indicate which deficiency

A

riboflavin, niacin, pyroxidine, iron

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40
Q

cheilosis (cracked, dry swollen lips) can indicate which deficiency

A

B2, B6, Niacin, iron

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41
Q

bloody gums can signify which deficiency

A

vitamin C

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42
Q

glossitis can signify which deficiency

A

riboflavin , B6, niacin, B12, folate, iron

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43
Q

swollen, beefy red tongue can indicate which deficiency

A

niacin

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44
Q

poor blanching (capillary refill) can indicate which deficiency

A

iron

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45
Q

koilonychia (Spoon shaped nails with raised edges) can indicate what deficiency

A

iron, protein (could be genetic)

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46
Q

reverse ridging of the nails/white banding can indicate

A

hypercalcemia

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47
Q

splinter hemorrhage could indicate which deficiency

A

vitamin A, vitamin C

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48
Q

flaky nails could indicate which deficiency

A

magnesium, selenium

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49
Q

products that act as free radical scavengers and co factors are

A

antioxidants

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50
Q

vitamins A, C, E, selenium and zinc are

A

antioxidants

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51
Q

critically ill patients may need more of this/these to reduce free radical damage, but have shown no increased benefit for mortality, LOS or ventilator time

A

antioxidants; provide the RDA of each

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52
Q

what is the recommendation of providing antioxidants on the ICU for critically ill patients

A

provide the RDA of each

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53
Q

vitamin needs in burns patients with <20% TBSA

A

provide daily multivitamin supplementation

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54
Q

MVI recommendations for burn patients with >/= 20% TBSA

A

increase MVI

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55
Q

Zinc recommendations for burn patients with > 20% TBSA

A

20,000 mg

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56
Q

Vitamin C recommendations for burn patients with >20% TBSA

A

500 mg

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57
Q

When should selenium and copper be provided to burn patients with >20% TBSA

A

BID IF deficient

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58
Q

plasma zinc levels are ____ indicators of nutrient deficincies

A

poor

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59
Q

what is the best indicator for B12 deficiency

A

MMA levels

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60
Q

night blindness indicates ____ deficinecy

A

vitamin A

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61
Q

bitot spots and hyperkeratosis indicates ___ deficiency

A

vitamin A

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62
Q

toxicity of vitamin A results in inhibited ____ growth and ___ disease

A

bone; kidney

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63
Q

populations at risk for vitamin A deficiency

A

fat malabsorption, pregnancy, malnutrition

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64
Q

what are the 2 forms of vitamin D

A

Ergocalciferol (D2) and Cholecalciferol (D3)

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65
Q

where is most of vitamin D absorbed

A

distal small intestine

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66
Q

vitamin D active form

A

1,25 dihydroxyvitamin D

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67
Q

which organs play a role in vitamin D

A

skin kidneys, liver

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68
Q

this form of vitamin d helps absorb calcium in the gut

A

calcitriol

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69
Q

symptoms of vitamin d deficiency

A

osteomalacia, tetany, hypocalcemia

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70
Q

patients on long term PN are at risk for vitamin D deficiency true or false

A

true

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71
Q

______ serum calcium signals the release of parathyroid hormone

A

low

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72
Q

Parathyroid Hormone increases calcium by

A

renal retention to make calcitriol, stimulates osteoclasts to break down bone, calcitriol stimulates the gut to increase calcium absorption

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73
Q

vitamin D deficiency is indicated in serum assays as

A

= 20 ng/mL

74
Q

treatment for vitamin D deficiency

A

50,000 IU every week for 9 weeks, and 1,000 IIU a day thereafter

75
Q

what is alphatocopherol

A

vitamin E

76
Q

where is vitamin E primarily absorbed

A

jejunum

77
Q

main function of vitamin E

A

antioxidant; traps free radicals

78
Q

populations at risk for vitamin E deficiency

A

fat malabsorption, chron’s , ileal /small bowel resection, long term TPN

79
Q

age spots, vision loss and anemia indicate ____ deficiency

A

vitamin E

80
Q

which vitamins are contraindicated with coumadin use

A

vitamins E and K

81
Q

the 2 forms of vitamin K

A

Phyllaquinolone and Menaquinonone

82
Q

where is vitamin K synthesized

A

intestines, gut microflora

83
Q

primary absorption site of vitamin K

A

jejunum

84
Q

main functions of vitamin K

A

blood clotting, PT time, INR, clots the blood

85
Q

there are high amounts of _____ in ILE fat emulsions which can affect a person’s INR

A

vitamin K

86
Q

ILE injections in TPN contain up to _____ micrograms of vitamin K

A

1,000 mcg

87
Q

If someone’s blood is thinning too much and their INR is elevated while on TPN with lipids what can be done

A

discontinue or decrease lipid infusion or take out the multivitamin as will high levels of vitamin K

88
Q

primary site of vitamin C absorption

A

ileum/jejunum

89
Q

this vitamin plays a role as an antioxidant, collagen synthesis, carnitine synthesis, increases iron absorption

A

ascorbic acid

90
Q

delayed wound healing, petechia, bleeding gums, corkscrew hair, and decreased immune function are symptoms of which deficiency

A

vitamin C

91
Q

toxicity of vitamin C can lead to

A

renal stones

92
Q

vitamin C recommendations for stage 1 to 2 pressure wounds

A

100-200 mg/day

93
Q

vitamin C recommendations in known vitamin C deficiency

A

100mg 3x/day

94
Q

primary site of thiamine absorption

A

jejunum

95
Q

what is the most common cause of B1 deficiency

A

alcoholism

96
Q

energy production, synthesis of NADPH, CHO metabolism, and role in KREBS cycle are the roles of what micronutrients

A

thiamine

97
Q

Beri Beri is a manifestation of which vitamin deficiency

A

thiamine

98
Q

populations at risk for thiamine deficiency

A

gastric bypass, alcoholism, hyperemesis gravidarum, LTPN, malnutrition, lasix

99
Q

thiamine deficiency causing psychosis and memory disturbances and fatal lactic acidosis

A

Wernicke Korsakoff

100
Q

nystagmus of the eyes, lower extremity weakness, cardiac failure, sodium/water retention, increased lactic acid are symptoms of what deficiency

A

thiamine deficiency

101
Q

How much thiamine is recommended for asymptomatic B1 deficiency in PN

A

5-20 to 300 mg daily (replete magnesium/lasix)

102
Q

thiamine recommendations for wernicke’s encephaloopathy

A

100-200 mg IV or IM 3x/day for 3-5 days

103
Q

maintenance thiamine supplementation for wernicke’s encephalopathy

A

100 mg oral B1 3x/day for 1-2 weeks

104
Q

this micronutrient makes up flavinmononucleotide and flavin dinucleotide

A

riboflavin (B2)

105
Q

absorption of riboflavin occurs primarily in

A

small intestine enhanced by bile salts

106
Q

this micronutrient plays a role in the electron transport chain, antioxidant against lipid peroxidation

A

Riboflavin (B2)

107
Q

Sebhorric dermatitis, cheilosis, angular stomatitis and glossitis are symptoms of what deficiency

A

riboflavin

108
Q

forms of Niacin (B3)

A

Nicotinic acid, nicotinamide

109
Q

B3 (niacin) can be synthesized from

A

tryptophan

110
Q

this micronutrient nakes up NAD,NADP, is a hydrogen donor in metabolism and activates folate

A

niacin (B3)

111
Q

pellagra dermatitis is a symptom of ____deficiency

A

niacin (B3)

112
Q

this micronutrient plays a role in metabolism or nutrients, central nervous system development, immune function and conversion of homocysteine to cysteine

A

pyroxidine (b6)

113
Q

this micronutrient makes up GTAC of DNA

A

pyroxidine (b6)

114
Q

what is the active form of vitamin B12

A

methylcobalamine

115
Q

absorption of vitamin B12 depends on

A

intrinsic factor

116
Q

populations at risk for B12 deficiency

A

use of PPIs, ileal/cecal valve removal, H. Pylori, vegans

117
Q

cognitive decline, dementia, osteoporosis and GI symptoms are manifestations of which deficiency

A

B12

118
Q

typical dose of vitamin B12

A

100-1000 mg

119
Q

deficiency of vitamin B12 leads to ____ anemia

A

megaloblastic anemia (pernicious anemia)

120
Q

B12/megaloblastic anemia can be masked by ______ deficiency

A

folate

121
Q

Vitamin B12 converts homocysteine to

A

methionine

122
Q

Vitamin B12 makes up the enzyme methylcobalamin which is a cofactor for methionine synthase which converts homocysteine to methionine. B12 also makes up the enzyme 5-adenosylcobalamin to become tetrahydrofolate. B12 deficiency will trap the conversion of folate. B12 and Folate will both be low

A

Methyl Folate Trap

123
Q

Megaloblastic anemia (pernicious anemia) results in either ____ or ___ deficiency

A

B12 or Folate

124
Q

Formal name of folic acid/folate

A

Folate/Tetrahydrofolate

125
Q

primary absorption of folic acid occurs in the

A

jejunum

126
Q

folate absorption depends on this micronutrient

A

zinc

127
Q

folic acid absorption is inhibited by _____ and ____

A

zinc deficiency and impaired bile flow

128
Q

This micronutrient plays a role in amino acid and nucleic acid metabolism, synthesis of purines/pyrimidines (DNA) and helps convert homocysteine to methionine

A

folic acid

129
Q

populations at risk for folate deficiency

A

pregnancy, Gastric bypass

130
Q

folate deficiency results in _____ anemia

A

megaloblastic anemia

131
Q

cheilosis, dementia, weight loss, and megaloblastic anemia are symptoms of ____ deficiency

A

folate

132
Q

medications that interfere with folate

A

phenytoin, birth control, rifampin

133
Q

biotin is primarily absorbed in the

A

jejunum

134
Q

biotin can be synthesized by

A

gut flora

135
Q

skin pallor, dermatitis, glossitis, cheilosis, lethargy and alopecia are all sx of ____ deficiency

A

biotin

136
Q

Pantothenic acid (B5) is a major component of

A

Con enzyme A

137
Q

This nutrient plays a role in fatty acid metabolism, ketogenic amino acid, bile salt/steroid/hormone synthesis, beta oxidation and the kreb’s cycle

A

Panthothenic acid (co-enzyme A)

138
Q

This micronutrient converts phospholipids into lecithin (phosphotidylcholine)

A

choline

139
Q

this micronutrient plays roles in the formation of lecithin, acetyl choline synthesis and production of lipoproteins

A

choline

140
Q

Populations at risk for choline deficiency

A

long term PN, pregnancy, hypermetabolic state

141
Q

hepatotoxicity especially on TPN without supplementation can be a result of _____ deficiency

A

choline

142
Q

choline deficiency is typical in ______ syndrome and _____

A

short bowel and long term TPN

143
Q

_____ is a component of intralipid 20% solutions’ as an emulsifyer (lecithin)

A

choline

144
Q

which form of iron is best absorbed in the gut

A

Ferrous Form Fe2+

145
Q

_____ enhances heme/non heme iron absorption

A

ascorbic acid

146
Q

Iron is primarily absorbed in

A

the duodeum/jejunum

147
Q

____ reduces iron in the Ferric Form (3+_) to the Ferrous Form (Fe2+)

A

ascorbic acid

148
Q

populations at risk for iron deficiency

A

child bearing age, excess blood loss, older adults, antacid/PPI/H2 receptor antagonist use, gastric bypass, chron’s disease, pernicious anemia, celiac disease

149
Q

what type of anemia is microcytic, hypochromic with decreased MCV

A

Iron Deficiency Anemia

150
Q

Koilynchia, glossitis, poor capillary refill and fatigue are symptoms of ______ deficiency

A

iron

151
Q

Why isn’t iron routinely added to PN

A

it can cause microbial growth

152
Q

if iron MUST be added to PN which form is preferred

A

Fe dextran

153
Q

Iron dextran cannot be added to a TNA becuase

A

it will destabilize the solution

154
Q

this form of iron cannot be added to a TNA TPN mixture

A

Fe Dextran

155
Q

Zinc absorption relies on ____ release from the stomach

A

HCL

156
Q

Zinc absorption is inhibited by these medications

A

acid reducers

157
Q

zinc is bound to _____ which is abundant in the body, so serum levels are not the most accurate

A

albumin

158
Q

this mineral is part of the makeup of metalloenzymes, plays a role in wound healing, insulin synthesis, immune function and glucose control

A

zinc

159
Q

Excess zinc can cause _____ deficiency

A

copper

160
Q

Increased zinc can cause copper deficiency because

A

they fight for the same receptor

161
Q

Rash, scaly dermatitis, poor wound healing, alopecia, altered taste/smell, decreased immune function and Iron deficiency anemia are all results of ____ deficiency

A

zinc

162
Q

populations at risk for Zinc deficiency

A

older adults, ETOH use, wound drainage , GI losses from DIARRHEA, DIARRHEA, liver disease HIGH OUTPUT FISTULA

163
Q

without food sources how quickly will iron deficiency occur

A

6 months

164
Q

is iron in standard trace elements

A

no

165
Q

without thiamine, pyruvate will convert to

A

lactic acid

166
Q

wound healing, cell differentiation, epithelial cell development and collagen synthesis are functions of

A

vitamin A

167
Q

vitamin toxicity for vitamin A can occur over ____ IU a day

A

25,000 IU/day

168
Q

aluminum appears in TPN becaus

A

of aluminum contamination during manufacturing

169
Q

how can you reduce aluminum toxicity

A

reduce or eliminate aluminum containing antacids, sucralafate

170
Q

deferoxamine

A

a medication to treat almunium toxicity

171
Q

patients receiving long term PN are most likely to have increased requirements above the RDA of

A

selenium

172
Q

a deficiency in this vitamin can lead to lactic acidosis and death

A

thiamine (B1)

173
Q

vitamin D and parathyroid hormone regulate calcium metabolism in the

A

intestines
bone
kidneys

174
Q

a patient with vitamin A deficiency is likely to manifest the following symptom

A

dermatitis

175
Q

supplemental zinc may impair the absorption of this nutrient

A

copper

176
Q

the following lab value is likely to be low in acute pancreatitis

A

Calcium

177
Q

the adjusted calcium for a patient with a serum albumin of 2.4 and serum calcium of 7.2 is

A

8.5

178
Q

Iron is best absorbed in the

A

duodenum

179
Q

the usual parenteral dose of selenium is

A

50-100 mcg

180
Q

cheilosis (cracked corners of the mouth) indicates deficiency of

A

riboflavin, niacin, Fe, pyridoxine

181
Q

Action of Proton Pump Inhibitors and effect on B12 absorption

A

Protein is bound to vitamin B12. Absorption requires optimal gastric acid to cleave B12 from the protein in food and bind to intrinsic factor. Free B12 will bind to R protein then Intrinsic factor in the small intestine for absorption. PPI’s decrease HCL which will interfere with absorption

182
Q

serum creatinine is mostly influenced by the amount of a person’s

A

muscle mass; the lower the muscle mass the lower the creatinine

CNSC Exam (32 decks)

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