MIDTERM Flashcards by Sara Gibbons

What is the physiological origin of the alkaline tide?

Stomach acid production

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The Heidelberg capsule is a device that was developed for clinical assessment of what function?

A. Small intestine residence time
B. Gastric acid output
C. Pancreatic enzyme output
D. Bile flow

B. Gastric acid output

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Why is the flow of amino acids and vitamins from the gut to the liver not accompanied by dietary fatty acids?

A. Rates of fatty acid absorption are more distal in the stomach
B. Fatty acids are transferred into the lymphatic flow
C. Absorbed fatty acids are incorporated directly in VLDL

B. Fatty acids are transferred into the lymphatic flow

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What is the long-term major difference in prognosis between a positive IgE response and positive IgG4 response

A. No food avoidance is needed for IgG4 reactions
B. Only short-term food avoidance is needed for IgE reactions
C. IgG4-reactive patients may resume eating reactive foods when the gut is healed
D. There are no differences in management

C. IgG4-reactive patients may resume eating reactive foods when the gut is healed

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Which type of food-specific antibody is able to both block IgE responses and persist for many days as a multi-antigen-binding complex?

A. IgG4
B. IgG1
C. IgG2
D. IgG3

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High fecal fatty acids can arise from lack of which digestive function?

A. Bile acid secretion
B. Adequate stomach residence time
C. Carbohydrate malabsorption
D. Immune barrier dysfunction

A. Bile acid secretion

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Which biomarker can be used to assess chronic elevated intestinal permeability?

A. sIgA
B. Isobutyrate
C. IgG4
D. IgGE

C. IgG4

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In which class of immunoglobulin are the transmembrane Fc. regions not joined by disulfide bonds?

A. IgE
B. IgA
C. IgM
D. IgG

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General insufficient secretion of pancreatic enzymes leads to which metabolic outcome?

A. Low fecal fats
B. Low polyunsaturated fatty acids in the plasma
C. Low gastric pH
D. Low vitamin B12

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In what anatomical region of the gut does the most rapid increase in commensal bacteria growth occur?

A. Ileum
B. Cecum
C. Transverse colon
D. Sigmoid colon

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What unique metabolic product of desulfovibrio pinger is thought to confer cardiovascular disease protection?

A. Chondroitin
B. Acetate
C. Vibrio antigen
D. Hydrogen sulfide

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Why are mealtime habits so important for achieving a healthy gut micro biome that resists challenges from pathogens and occasional food indiscretions?

A. They allow much more robust growth of Lactobacillus
B. Such habits improve digestive function and GI residence time
C. Anxiety while eating raises cortisol to very high levels
D. They allow the stomach to empty faster, lowering caloric load

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What target has the greatest mid-range levels in the healthy population?

A. Bifidobacter
B. Clostridium
C. Faecalibacterium
D. Fusobacterium

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**Which target can confer protection against intestinal inflammatory responses when it is present at normal levels?

A. Prevotella
B. E. Coli
C. Bactericides
D. Faecalibacterium prausnitzii

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** Which best describes the effect of robust, balanced growth of normal commensal bacteria on most intestinal pathogens

A. Stimulation of pathogen growth
B. Suppression of growth and pathogenicity
C. Higher rates of pathogen DNA mutations
D. Hyperimmune states and inflammation

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** The single archaeon found in appreciable levels in most healthy people requires the presence of what substrate for growth?

A. Hydrogen
B. Methanol
C. Amylose

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**What advantage is gained by reporting bacteria levels in units per microgram of feces?

The results can read as simple integer values

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** Why is robust growth needed for normal high-abundance commensal bacteria to reach levels that sustain a healthy gut microbiome?

Most of the them must pass into the anaerobic cecum before active growth can begin

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What best describes fecal material in people with a healthy gut microbiome?

Large, soft logs

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**Which of the following factors does not impact alpha-tocopherol levels

A. Canola oil
B. Almonds
C. Fat malabsorption
D. Hyperglycemia

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Which compound is measured as a laboratory test for vitamin K deficiency?

A. 7-Dehydrocholesterol
B. Under Carboxylated osteocalcin
C. Dehydroascorbic acid
D. Sepiapterin

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Assessment of vitamin D deficiency is done by measuring serum levels of what compound?

A. Calcitriol
B. Previtmain D3
C. 25-Hydroxyvitamin D
D. 1,25-Dihydroxyvitamin D

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A patient can have normal serum vitamin B12, but still show elevated urinary MMA because:

A. The folate trap prevents proper methylation
B. Vitamin B12 promotes the formation of methylmalonate
C. Methylmaonate causes anemia from folic acid deficiency
D. Methylmalonate metabolism requires intra-cellular activity of vitamin B12

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Which vitamin insufficiencies can indicate elevated branched-chain keto acids in urine?

A. B-complex
B. Antioxidants
C. Cholecalciferol
D. Ascorbate

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** Why is it incorrect to speak of a “folic acid” deficiency A. Folic acid is not commonly found in many food sources B. Folic acid is highly toxic C. Folic acid is not a naturally occurring nutrient D. Human tissues can synthesize folic acid

Dysbiosis is a risk factor for all of the following nutrient depletions, except: A. Vitamin B12 B. Vitamin D C. Vitamin K2 D. Biotin

Plasma levels of which compounds becomes elevated as a sign of failure in the methyl group supply pathways? A. Homocysteine B. Glycine C. Betaine D. Glycine

Supplementation of which conditionally essential nutrient would be indicated is laboratory testing showed blood sugar dysregulation, and low levels of lactate and pyruvate? A. Ubiquonoine B. Threonine C. Glycine D. Alpha-lipoid acid

Human tissue production of which conditionally essential nutrient consumes the greatest fraction of daily active methyl groups? A. Carnitine B. Creatine C. Ubiquinone D. Lipoic acid

Mitochondrial deficiency of which compound is considered a cause of chronic oxidative stress due to the generation of superoxide radicals? A. Choline B. Glycine C. Ubiquinone D. Creatine

Which of the following compounds participates in fatty acid transport across the mitochondria membranes? A. Choline B. Carnitine C. Ubiquinone D. Creatine

Finding low levels of which amino acid in plasma is a marker of potential poor methylation status? A. Aspartate B. Proline C. Glycine D. Glutamine

What compound is produced as a immediate product when methyltransferase enzymes carry out their reactions? A. NADPH B. SAH C. Hydroxylated fatty acid D. Alpha-ketoisovalerate

A person with insufficient ability to synthesize carnitine is likely to have elevated levels of which biomarker? A. Citrate B. Suberate C. Methylmalonate D. Alpha-Hydroxyisovalerate

** What organ failure most directly causes multiple low trace elements to be found in the blood and urine A. Pancreas B. Liver C. Stomach D. Kidney

Which mineral is integral in immune function as well as GI integrity? A. Iron B. Selenium C. Zinc D. Magnesium

** Why does direct testing of calcium in body fluids fail to reveal nutritional status? A. Strong mechanisms assure ionic calcium levels in calcium deficiencies B. Other elements interfere with the measurement of calcium in body fluids C. Calcium presents at levels too low to detect in body fluids D. Calcium levels in body fluids change too rapidly to allow interpretations of calcium balance

Which of the following is NOT useful for assessing iron status? A. Total iron binding capacity B. Serum ferritin C. Transferrin saturation D. Hair iron concentration

Finding high levels of serum ferritin in an indication of what condition? A. Copper deficiency B. Copper excess C. Iron deficiency D. Iron excess

A patients which chronic negative calcium balance is expected to have elevated calcium in which specimen? A. Unchallenged 24 hr urine B. Whole blood C. Head hair D. Erythrocytes

What amino acid accounts for the high metal ion binding capacity of metallothionein? A. Methionine B. Glutamic acid C. Cysteine D. Histidine

Which amino acid is converted into a neurotransmitter by two sequential hydroxylation reactions requiring tetrahyobiopterin as a cofactor? A. Glutamic acid B. Tryptophan C. Valine D. Phenylalanine

A pattern of elevated essential amino acids is an early sign of deficiency of what vitamin? A. Vit A B. Vit C C. B12 D. B6

Which medical condition is often found in patients with elevated plasma asymmetric dimethylarginine? A. Chronic fatigue B. Maldigestion C. Hypertension D. Food allergies

What metabolic process creates the largest demand for amino acids? A. Neurotransmitter synthesis B. Hepatic detoxification C. Protein synthesis D. Hydrochloric acid production

Which amino acid is a substrate for competing reactions that lead to either a compound that supplied a methyl group or to a compound that supplies protection from oxidative stress? A. Taurine B. Homocysteine C. Asparagine D. Proline

Elevations in the following group of compounds is associated with depletions in vitamins B1, B2, B3, B5, and lipoic acid but NOT B6 A. Branches chain ketoacids B. GABA C. Sacrosanct D. BCAAs

What amino acid is implicated in the balance of both the urea and nitric oxide cycles? A. Homocysteine B. Glutamine C. Arginine D. Lysine

** What is the principal metabolic outcome of the glycine cleavage system? A. Protein synthesis B. Inhibition of the pathway that leads to heme synthesis C. Generation of 5-10-methylene THF D. Regeneration of tetrahydrobiopterin

** What fatty acid is part of the structure of the most active endocannbinoids?

DHA 22:6n3 is ?

Docasanhexaenoic acid

Which omega 3 fatty acid tends to become persistently low in patients using fish oil supplements?

ALA (or DGLA)

** Into what categories are the fatty acids typically placed on laboratory reports? (X4)

Saturated, monounsaturated, polyunsaturated, trans-fatty acids

** What fatty-acid pattern is associated with metabolic syndrome ?

“Greater than” pattern (elevated C16,18,20)

** Which are not saturated fats? ``` A. Palmitic B. Myristic C. Lauric D. Oleic E. Stearic ```

** Which is NOT an omega 3 fatty-acid? A. Linoleic acid B. EPA C. Linolenic acid D. DHA

** T/F unsaturated fat is high in nuts, seeds, olives, grass-fed animal sources, and fatty fish?

** What clinical syndrome is indicated by findings a “greater than” sign in the family of saturated fatty acids?

Hyperinsulinemia/Metabolic Syndrome

LA 18:2n-6 is?

Linoleic acid

AA 20:4n6 is?

Arachandonic acid

T/F Protease is needed to emulsify fat in the stomach and to begin digestion of fat

F; LIPASE is needed

ALA 2:4n6 is ?

Alpha-linolenic acid

EPA 2:5n3 is ?

Eiscosapentaenoic acid

T/F The higher the density (lipoprotein), the more protein in contains?

LDL takes cholesterol from X to the rest of the body?

Liver

HDL takes cholesterol from X and brings to Y?

from the BODY back to the LIVER

Are LDL or HDL DIRECT or INDIRECT markers of cholesterol?

Indirect, but we can assume that when LDL is elevated, more cholesterol is being made in the liver and when HDL is elevated, it means its doing its job of brining cholesterol back/cleaning up

** How many phyla of bacteria usually account for all of microbes in feces of healthy humans? A. 4 B. 2 C. 7 D. 6

Which lipoprotein is responsible for “reverse cholesterol transport”

HDL

Why are smaller lipoproteins more dangerous?

There are more dense/harder particles and therefore when they knock up agains the epithelium, they create more damage than the more fluid/larger particles

T/F Numbers and sizes of LDL particles is influenced by oxidative damage to those particles?

** Describe the fatty acid profile imbalance that tends to exaggerate the inflammatory response?

- Elevation AA/EPA ratio - High triglycerides - High SMALL particle LDL - Low HDL

** Which is NOT an eicosinoid (n20) ? A. DGLA B. DHA C. AA D. EPA

Series 1 inflammatory pathways comes from which eicosinoid? Series 2? Series 3?

Series 1: DGLA Series 2: AA Series 3: EPA

If a plasma amino acid profile shows low levels of four essential amino acids and normal levels of the others what intervention is generally indicated? A.) A high fiber diet to reduce intestinal transit time B.) A combination of antioxidants and the trace elements Zn, Cu and Mn C.) Supplementation of the amino acids that are low at about twice their RDA levels D.) A customized mixture of all essential amino acids

The principal advantage of free form amino acid supplements over purified protein products is A.) Lower risk of producing nitrogen overload B.) Greater penetration into distal regions of the gut lumen C.) More rapid delivery of amino acids into peripheral blood D.) Lower risk of gall bladder attacks due to release of cholegogues

Which abnormality pattern, when found on a plasma fatty acid report, indicates that a patient is in general essential fatty acid deficiency? A.) Elevated stearic/oleic ratio B.) Low ALA, EPA, DHA and high stearic acid C.) Low Mead and palmitic acids D.) Low omega 3 and omega 6 with elevated Mead acid

``` Which abnormality pattern, when found on a plasma fatty acid report, indicates that a patient is in omega-3 fatty acid deficiency? A.) Low stearic/oleic ratio B.) Low ALA and EPA C.) Low LA, DGLA and AA D.) High palmitic/palmitoleic ratio ```

Which abnormality pattern, when found on a plasma fatty acid report, suggests that a patient may be hypertriglyceridemic? A.) An elevated triene/tetraene ratio B.) Low levels for all omega-3 and omega-6 fatty acids C.) All saturated and monounsaturated fatty acids found in their 4th or 5th quintiles D.) A low triene/tetraene ratio

Which abnormality pattern, when found on a plasma fatty acid report, indicates that a patient is exhibiting the metabolic syndrome? A.) Generally low monounsaturated fatty acids and a high LA/GLA ratio B.) Generally high monounsaturated all fatty acids with chain lengths of less than 20 carbons C.) A "greater than" sign in quintile positions of the saturated fatty acids when they are arranged according to chain length D.) A "less than" sign in the quintile positions of the saturated fatty acids when they are arranged according to chain length

Which abnormality pattern, when found on a plasma fatty acid report, indicates a patient has adrenoleukodystrophy? A.) Greatly elevated lignoceric and hexacosanoic acids with normal levels of other saturated fatty acids B.) Greatly elevated capric and lauric acids with normal levels of other saturated fatty acids C.) Very low levels of monounsaturated fatty acids with gradually increasing levels of saturated fatty acids as chain length decreases. D.) Simultaneous very high Mead, palmitoleic, and vaccenic acids with normal levels of myristoleic and erucic acids

``` Finding multiple odd-chain fatty acids in erythrocytes means that there is some process causing elevated levels of which compound? A.) Stearate B.) Fumarate C.) Erucate D.) Propionate ```

``` Which fatty acid source is appropriate for treatment of a patient with ALA and EPA in their upper quintiles and with LA and GLA in their first deciles? A.) Flax oil B.) Primrose oil C.) Fish oil D.) Corn oil ```

``` What is the common name for the fatty acid written as 20:4n6? A.) Arachidonic acid B.) GLA C.) EPA D.) Linoleic acid ```

``` What cellular organelles other than mitochondria are required for VLCFA degradation? A.) Peroxisomes B.) Smooth endoplasmic reticulum C.) Rough endoplasmic reticulum D.) Liposomes ```

``` Which vitamin is necessary for stimulation of PPAR? A.) Riboflavin B.) Vitamin A C.) Niacin D.) Folic acid ```

``` Which amino acid, when administered as a challenge for testing status of a vitamin, helps to alleviate one of the effects of deficiency of the vitamin? A.) Tryptophan B.) Phenylalanine C.) Histidine D.) Isoleucine ```

What effect does delayed specimen transport have on relative levels of glutamate and glutamine? A.) The levels are stable for at least one week. B.) Glutamine is consumed by enzymes in plasma C.) Glutamate decreases due to changes in pH D.) Glutamine is slowly hydrolyzed to glutamate

``` What element has been shown to protect from the toxic effects of mercury? A.) Copper B.) Selenium C.) Zinc D.) Magnesium ```

``` The action of what hormone is reduced in chromium deficiency? A.) Insulin B.) Testosterone C.) Thyroxine D.) Glucagon ```

Which of the following is a good test for copper excess? A.) RBC Cu B.) Urinary copper C.) Low serum copper to ceruloplasmin ratio D.) Urinary HVA/VMA ratio

``` When very low erythrocyte magnesium is found, the patient is likely to have what other type of insufficiency? A.) Selenium B.) Iron C.) Glutathione D.) Vitamin C ```

A DMSA provocation test would usually be done to assess what problem? A.) Trace element loss due to renal retention deficit B.) Toxic element exposure C.) Hypothyroidism due to iodine malabsorption D.) Bone loss due to calcium deficiency

What does the abbreviation BH4 represent? A.) A part of vitamin B12 structure B.) A catabolic product of vitamin B6 C.) Tetrahydrobiopterin D.) A test for B-complex vitamin deficiency

Vitamin B6 deficiency causes elevated homocysteine by what mechanism? A.) Accelerating the conversion of methionine to homocysteine B.) Blocking the transfer of methyl groups to THF C.) Impairing the conversion of homocysteine to cysteine D.) Reducing the active form of vitamin B12

``` Which of the following is NOT a folate deficiency sign? A.) Plasma homocysteine elevation B.) Neutrophyl hypersegmentation C.) Urinary xanthurenic acid elevation D.) Urinary formiminoglutamate elevation ```

When serum lipid peroxides are elevated even though all serum antioxidant vitamins are in their upper normal ranges, what other abnormality is likely to be present? A.) High vitamin D B.) High polyunsaturated fatty acids in plasma C.) Low polyunsaturated fatty acids in plasma D.) Low biotin

``` Finding elevated urinary alpha-ketoisocaproate and alpha-ketoisovalerate is an indication of what essential nutrient deficiency? A.) Coenzyme Q10 B.) Vitamin B1 C.) Vitamin B6 D.) Vitamin D ```

``` What amino acid is unusually high inside erythrocytes to afford oxidative stress protection? A.) Taurine B.) Threonine C.) Thyroxin D.) Tyrosine ```

``` 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 patient who has been on SSRI medications for 2-3 years is most likely to have a deficiency of which amino acid? A.) Tryptophan B.) Gamma-aminobutyric acid C.) Phenylalanine D.) Glutamic acid ```

``` 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 ```

``` Choline is a derivative of which amino acid? A.) Glycine B.) Glutamine C.) Glutamate D.) Glutathione ```

``` 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 ```

``` Which of the following is the most abundant PUFA in the average American diet? A.) Linoleic B.) Oleic C.) GLA D.) ALA ```

``` A patient with biotin deficiency is likely to show elevated levels of which fatty acid? A.) Nonadecanoic B.) Lignoceric C.) Myristoleic D.) Lauric ```

``` What is the principal form of circulating fatty acids in the fasting state? A.) LDL B.) Chylomicrons C.) HDL D.) Free fatty acids ```

``` 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 ```

``` 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 ```

``` Use of which specimen for measuring potassium concentrationhas the strongest scientific support for assessing potassium deficiency? A.) Erythrocyte B.) Serum C.) Hair D.) Urine ```

``` Measuring levels of which serum protein can providedirect information about a patient's copper status? A.) Ceruloplasmin B.) Ferritin C.) Albumin D.) Prealbumin ```

Why do microbiological culture techniques performed in routine clinical laboratory services fail to detect the large majority of bacteria that occur in stool specimens? A.) The bacteria are strict anaerobes B.) Specimen transport produces falsely elevated results C.) There are no growth media with adequate nutrient compositions D.) Organotoxins suppress the growth of most bacterial in cell culture A.) The bacteria are strict anaerobes

``` Your patient reveals that s/he has been supplementingwith high doses of fish oil for years and always cooks with safflower oil and cornoil. Based on this information, what analyte(s) would you suspect might be elevated? A.) Suberate B.) Adipate C.) Lipid peroxides D.) Both a. and b. are valid responses ```

``` When a patient is found to have high levels of LA and GLA, but a low level of DGLA on a plasma fatty acid profile, what specific nutrientintervention is suggested? p 292 A.) Zinc B.) Iron C.) Primrose oil D.) Fish oil ```

``` Insufficiency of which hormone is associated with impaired conversion of beta carotene to vitamin A? A.) Thyroid B.) DHEA C.) Cortisol D.) Insulin ```

Why would dietary protein intake not be expected to produce elevated levels of amino acids in plasma when the test is done according to usual specimen collection instructions? A.) After more than six hours, amino acids from dietary protein do not affect peripheral blood amino acid concentrations. B.) The liver prevents any amino acids from dietary protein from entering systemic circulation. C.) Amino acids are absorbed largely by transfer into the small intestinal lymphatic system. D.) The instructions usually say that no protein is to be consumed on the day before the specimen collection is performed.

``` A patient with simultaneous strong elevations of urinary citrate, cis-aconitate, isocitrate and orotate is also likely to be exhibiting which other laboratory abnormality? A.) Ammonemia B.) Hypercholesterolemia C.) Lipidemia D.) Hyperglycemia ```

``` Elevation of which compound indicates that inflammatoryresponses are occurring in the brain? A.) Quinolinic acid B.) Hydroxyphenylacetic acid C.) Orotic acid D.) p-Hydroxyphenyllactic acid ```

``` Which specific nutrient supplementation is most directly indicated for a patient with a greatly elevated plasma phenylalanine to tyrosine ratio? A.) Iron B.) L-Phenylalanine C.) N-Acetylcysteine D.) Mixed tocopherols ```

Increased PUFA intake signals the human fat-sensing system to stimulate which process? A.) Peroxisome proliferation B.) Peroxisome degradation C.) Mitochondrial transport of saturated fatty acids D.) Electron transport system uncoupling

``` Essential fatty acid deficiency results in rising levels of which fatty acid? A.) Palmitoleic B.) Arachidonic C.) Linoleic D.) Hexacosanoic ```

What element is involved in the optimization of vitamin D status?

Magnesium

Intestinal assimilation of which nutrient is assessed by the Schilling test?

B12

T/F plasma is the preferred specimen for evaluation of FA imbalance?

What are the 7 components/categories included in fatty acid lab reports?

1. Omega 3 2. Omega 6 3. Omega 9 4. Monounsaturated 5. Odd chain 6. Trans 7. Ratios

Low palmitic acid is associated with what vitamin def?

Biotin

What microbe needs to be present in the gut in infants for establishing tolerance and surveillance for certain commensal?

Bifidobacterium Longum

What is the most dominant genus of bacteria in feces of a healthy individual?

Bactericides/firmicutes

** T/F 8Oh-Dg is a marker of poor methylation?