Nutrition

Question 1

Basal Metabolic Rate

• what is it?
• takes into consideration
• age
• equation
• importance

Answer 1

• amount of energy expended on daily basis at rest
• lean body mass and size
• decreases
• 10 (kg) + 6.25 (cm) - 5 (age) +5 men//-161 female
• know how much nutrition the patient needs in order to heal

Question 2

visceral fat

• surrounds
• importance
• high amnt related to
• inflammatory state

Answer 2

• internal organs
• helps to maintain body temp
• type 2 DM
• athersclerosis

Question 3

Waist to Hip Ratio

• what is it
• male
• female
• high associated with

Answer 3

• circumference of waist over circumference of hip
• 0.85-0.9
• 0.75-0.80
• insulin resistance, diabetes, metabolic syndrome

Question 4

Metabolic Syndrome

• what is it
• importance

Answer 4

• HTN, high sugar, high cholesterol, excessive fat around waist
• increases risk of diabetes, stroke, heart disease

Question 5

BMI

• equation
• normal
• overweight
• moderately obese
• severely obese
• very severely obese
• athletes

Answer 5

• (lb)/ (in) * 703
• 18.5-24.9
• 25-30
• 30-35
• 35-40
• > 40
• have elevated BMI

Question 6

Anorexia

• what is it
• epi
• normal daily caloric intake
• hormones
• signs and sxs
• other dx
• nervous sxs complications
• CV compications: pulse, BP, ECG changes, rhythms; mechanical problems
• Heme complications
• MSK complications
• Renal complications
• GU complications
• GI complications
• prognosis

Answer 6

• significantly low weight
• 13-18 yrs; 3-5% of people in world have anorexia
• 600- 800 calories
• amenorrhea bc loss of pulsatile GnRH -> low LH and FSH -> low estrogen -> no ovulation; increased cortisol
• excessive exercise; fine weight hair; hair loss; hypokalemia; meal time rituals; always on diet; depression; fatigue; irrational fear of gaining weight
• OCD
• decreased cognition w/ grey and white matter changes -> white matter is restored with weight gain; seizures; increased pain threshold and changes in thermoregulation
• decreased pulse and BP; AV block; QT prolongation; ST depression; T wave inversion; SVT or Vtach; decreased LV function, increased risk mitral valve prolapse
• Pancytopenia
• SM dysfunction and osteroporosis; increased growth hormone w/ decrease in insulin like growth factor -> growth arrest/ delay
• Proteinuria, decreased GFR, and all electrolytes will be decreased
• increased ammonium urate stones
• abnormal LFT
• 20% die -> arrhythmia and suicide

Question 7

Bulimia Nervosa

• what is it
• body stature
• look for
• health consequences

Answer 7

• binging and purging
• normal BMI or slightly over weight
• erosion of teeth, enlarged parotid glands
• HTN, DM2, CAD, OA, Sleep apnea, CA (bc of extra adipose tissue releasing estrogen)

Question 8

Fat soluble vitamins

Answer 8

• D, A, K, E

Question 9

Vitamins

Answer 9

• A, B, C, D, E, K

Question 10

Minerals

Answer 10

-

Question 11

Vitamin D

• source
• used for
• deficiency in kids vs adults
• complications
• activation
• 25 OH D3 function
• 1,25 di-OH D3 function
• PTH
• calcitrol
• breast milk
• vit D resistant rickets
• excess

Answer 11

• sunlight or veggies
• Ca homeostasis; intestinal absorption of Ca and phosphate in GI tract
• vit D rickets vs osteomalacia
• DM, bc Ca is responsible for exocytosis of insulin
• goes to liver and become 25 hydroxy D3, then to kidney to become 1-25 di hydroxy D3
• helps w/ atherosclerosis and prevents prostate and breast Ca
• increases insulin, increase mineralization of bone, decrease left ventricular hypertrophy, increases immune system, improves RBC creation
• increases osteoclast activation -> increase Ca and phosphate in blood -> and increase reabsorption of Ca in kidney and decreases reabsorption of phosphate
• decrease absorption of Ca at GI tract
• not sufficient in breast milk -> expose kid to sun or give droplets
• does not respond to only vit D, will continue to pee out phosphate so need to supplement oth vit D and phosphate to maintain Ca levels
• hyper Ca; stones, bones, moans (GI pain), groans, psych problems

Question 12

Vit E

• used for
• intake
• found in
• deficiency
• protects
• connections to Alzheimers

Answer 12

• anti- oxidants -> reduces glutathione
• 15 mg/ day
• leafy veggies, avocado, asp, broccoli
• RBC destruction, neuro consequences similar to Friedrichs ataxia, retinopathy, myopathy
• neurons
• delays

Question 13

Vit K

• used for
• source
• activated by
• needed for
• depletes fastest
• warfarin: ROA, pregnancy, moitor with, reversal; time frame; pathway affected
• heparin: MOA, pathway affected; measure with; side effects; reversal

Answer 13

• clotting
• 1: plants, 2: stored animal form
• gut flora -> new borns get shot of vit K
• 2, 7, 9, 10, protein C and S –> converts glutamyl into gamma-carboxyglutamate
• protein c which helps to break down clots -> causes a rash so need warfarin bridge
• oral, teratogenic; monitor PT and INR should be 2-3x normal -> means it takes 2-3x longer to clot; reverse warfarin with FFP and vit K; for clots leave on for 3 months; works on extrinsic pathway
• cofactor for anti-thorombin 3; works on intrinsic pathway because blocks thrombin formation and causes it to degrade; measure with PTT; can cause heparin induced thrombocytopenia when antibodies towards heparin start reacting to platelets; protamine sulfate

Question 14

Factor V Leiden

• most common cause of
• genetics
• what happens
• tx; why

Answer 14

• spontaneous clots
• auto DOM; arginine replaced wth glutamine on Factor V
• Factor V cannot be inactivated by protein C
• life long warfarin; even though factor V is on, if other factors cannot be activated then it wont react with the turned off factors

Question 15

Vit A

• role
• nyctalopia: what is it
• hereditary retinitis pigmentosa: what is it, caused by, different things seen
• toxic retinopathy
• skin: function, med
• bone: function, excess
• pregnancy: effects
• tox: amount, leads to, acute, chronic
• pseudotumor cerebri: what is it, sigs, sxs, imaging, side effects, tx

Answer 15

• vision, gene transcription, skin, bone, CSF
• poor night vision; can happen with decrease in vit A
• degeneration of rods and visual signals cannot be converted into electrical impulses
• optic nerve damage secondary to EtOH (everything turns white), amneodarone, digoxin (everythng turns yellow) and INH
• turns immature skin cells into mature epidermal cells –> accutane
• co-factor for PTH -> too much will increase PTH and cause hyper Ca
• teratogenic: cardiac anomalies, hydrocepahlus
• 10 X daily recommended value -> causes hepatic injury leading to cirrhosis; acute: N/V dizziness, chronic: dry skin
• excessive CSF production; papilledema, headache, CT with enlargement of ventricles -> causes blindness; stop vit A administration and serial lumbar punctures

Question 16

Thiamine

• also known as
• epi of deficient
• function
• dry beriberi: when, sxs
• wet beriberi: what is it, sxs, tx; prognosis w/o tx
• wernicke encephalopathy
• korsakoff
• tx for deficiency

Answer 16

• B1
• alcoholics
• required for dehydrogenase enzymes -> glucose metabolism, TCA, PPP
• occurs 2/3 weeks of cessation of intake; peripheral neuroapthy, myalgia, confusion, nystagmus;
• dry beriberi + congestive heart failure; peripheral edema, tachy, DOE, cyanosis; emergency tx with B1 and glucose; death in couple days
• acute onset of , destruction of mamillary bodies, tectal plates (auditory and visual reflexes), and thalamus -> reversible w/ tx
• damage to medial thalamus, mamillary bodies and atrophy of cerebral cortex -? memory impairment, emotional disturbances; not reversible
• thiamine first and then glucose -> if glucose first will cause lactic acidosis

Question 17

Wernicke- Korsakoff

• what is it
• impaired
• sxs
• signs

Answer 17

• acute onset of severe memory impairment
• mamillary bodies
• makes things up to try and fill in gaps in memory
• anterior and retrograde amnesia, does not talk much, false stories to fill memory gaps, apathy, lack of insight

Question 18

Vit B2

• also known as
• produces
• sources
• deficiency seen in
• deficiency signs

Answer 18

• Riboflavin
• FAD, FADH2
• cereal ,milk, nuts, veggies
• malnourished and alcoholics
• angular chelitis, corneal vascularization, mucus membrane inflamm, dry skin, photosensitivity

Question 19

Vit B3

• also known as
• produces
• needed in
• cholesterol
• side effects
• sxs of deficiency
• tox; what happens, pathway, prevention
• Hartnups: what is problem, sxs
• Carcinoid syndrome: what is problem, dx, sxs, normal location

Answer 19

• Niacin
• NAD, NADH
• TCA, glucose metabolism, ETC
• increase HDL, decrease VLDL -> LDL, and triglycerides
• pellagra (diarrhea, dermaitits, dementia, death)
• flushing (niacin converted into nicotinuric acid with conjugation; prevented by first giving aspirin), hepato tox ( niacin converted to nicotinamide through amidation), hyperglycemia, maculopathy
• can’t absorb tryptophan -> no niacin or serotonin; pellagra sxs
• tryptophan will be made into mostly serotonin instead of niacin; will see high amount of 5-hydroxyindoleacetic acid in urine; flushing, diarrhea, stenosis of risht heart valves, coughing, wheezing; small intestine

Question 20

Vit B4

• needed for
• used as tx for
• source

Answer 20

• TCA, pyruvate to acetyl CoA
• CAD, PAD, wound healing, metabolic syndromes, reduces alzheimers
• added to most foods

Question 21

Vit B5

• other name
• needed for
• deficiency: epi; sxs

Answer 21

• pantothenic acid
• It is CoA so needed for TCA
• malnourished patients; burning feet

Question 22

B6

• other name
• needed for
• source
• isoniazide
• pyridoxine dependent epilepsy

Answer 22

• pyridoxine
• heme synthesis, ALT and AST production, and synthesis of neuro transmitters
• tuna and chick peas
• depletes B6 by increasing excretion; always supplement when starting this medication
• causes seizures in infancy or before birth, cannot be controlled with anti-convulsants only controlled with therapeutic levels of B6

Question 23

B9

• other name
• function
• antagonized by
• pregnancy
• deficiency

Answer 23

• folate
• makes tetrahydrafolta -> needed to turn uricyl into thymidine -> RNA into DNA
• sulfa drugs in bacteria and methotrexate (dihydrofolate reductase) in humans
• needed for normal development of neural tube; make sure to supplement with folic acid for 12 weeks before trying to conceive
• cause megaloblastic anemia w/ hypersegnment nucleus because it cannot finish dividing; caused by over cookng ASP

Question 24

B12

• role
• neuropathy MOA
• storage
• pernicious anemia: pathway which leads to
• homocystinemia: problem, leads to, causes
• schilling test: steps

Answer 24

• needed to create tetrahydrofolate and convert homocysteine into methionine and methylmalonyl CoA into succinyl CoA (needed to recycle odd # fatty acids)
• methyl malonly CoA destabilizes myelin causing neuropathy
• 3- 5 years stored in liver -> so megaloblastic anmeia usually caused by folic acid def
• loos of intrinsic factor bs of gastric parietal cells loss -> cant absorb vit B 12 -> megaloblastic anemia
• wont be able to recycle homocysteine into methionine, and elevated homocysteine leads to PAD
• give pt IM shot of B12 -> give radiolabeled fluoro B12 -> then check urine for radio labeled B12 -> if there is radiolabeled B12 in urine then patient has B12 deficiency and normal absorption, if there is decreased radiolabeled B12 in urine then give another shot of radiolabeled B12 + intrinsic factor and then check urine again -> if B12 in urine then it is intrinsic factor deficiency but if no radiolaled B12 in urine then there is absorption problem (pancreatic insuff, or terminal illeitis)

Question 25

Vit C - needed for - other uses - deficiency: sxs, cause

Answer 25

- post translation modification of collagen (affects wound healing), elastin, and carnitine (transporting long chain FA into mito) - anti-oxidant - bleeding from gums and hair follicles; not getting enough vitamin from diet

Question 26

Calcium - needed for - citrate - hyper Ca: sxs, management, causes - renal osteodystrophy - hypo: cause; sxs; management

Answer 26

- bone mineralization, exocytosis of neurotransmitters, electrical conduction of heart - in blood products -> will bind to Ca - osteoporosis, rickets, malformation teeth - kidney stones, bones pain bc of hyperdensity of bones, GI upset w/ n/v, confusion/ lethargy, QT shortening, acute pancreatitis; oral hydration, thiazides; hyper PTH, malignancy, increase vit D and Ca intake, lithium (increases PTH) - secondary hyperparathyroidism; renal failure that does not allow to excrete phosphate so continue to reabsorb phosphate and Ca and they make Ca phosphate stones -> hypocalcemia -> release PTH -> and since kidneys messed up cannot make activated Vit D so decrease absorption of Ca in GI; phophate binder, supplement Ca and Vit D - parathyroid resection, low Mg, renal fialure; perioral numbness and tingling and numbness of fingers, chvosteks sign; Ca gluconate, vit D, supplement Ca

Question 27

Iron - absorption - storage - circulation - hepcidin

Answer 27

- proximal intestine, DMT 1 - binds to ferritin and stored in enterocyte - Uses ferroportin 1 to get into circulation, binds to transferrin which takes it to bone marrow to synthesize hemoglobin - hepcidin will inhibit ferroportin 1 and will not be able to transport iron in blood

Question 28

Phosphorus - function - deficiency: dysfunction of, causes, caused by, tx - hyper: causes, signs/sxs, management

Answer 28

- part of DNA, RNA, ATP, bone physiology, part of cell membranes - paralysis, fatigue, RBC dysfunction; will cause non-nutritional rickets; poor nutrition, decreased absorption, increased excretion; potassium phosphate or sodium phosphate - hypoPTH, neal insuff, rhabdomyolysis, tumor lysis. iatrogenic; soft tissue calcification and heart block; decrease phosphorus intake, AlOH phosphate binder, dialysis

Question 29

Sodium - function - hyper: caused by, sxs, tx - hypo: caused by, sxs, tx - effects of trying to over correct too quickly

Answer 29

- Na/K ATPase, and since water follows it regulated blood volume -> BP and osmostic equilibrium - steroid use, hypertonic fluid, loss hypotonic fluid; lethargy and weakness, seizure/ coma, shrunken brain; normal saline (will push Na into vessels) - trans urethral resection of the prostate (use irrigation fluid that is hypotonic which gets absorbs by prostatic sinusoids which dilutes out Na and adrenal insuff (no aldosterone, peeing out Na); seiaure, N/v, coma death, swollen brain; NS if >120 or 3% is <120 - dont correct too fost or it will lead to central pontine myelinolysis which causes locked in syndrome

Question 30

Potassium - function - hypo: caused by, sxs, tx - hyper: caused by (dx, meds, acid-base), EKG effects - digoxin tox: MOA, tx - kayexalate

Answer 30

- repolarization of cells - excessive vomitting and diarrhea, diuretics, renal disease that prevent reabsorption, eating disorders; arrythmias, fatigues, constipation, paralysis - renal failure, ACE i , K sparing diuretics, NSAIDs, TMP-sulfa, mineral corticoid deficiency (no aldosterone), acidosis (pseudo-- once acid base problem is fixed then K will move back into cell); peaked T waves and flat P waves w/ wide QRS complexes - binds to K/Na ATPase and blocks it causing increase of Na in cell, gets out thrrough Na/Ca antiporter -> increases Ca in cell -> pumps harder; activated charcoal, insulin + glucose, and digoxin-specific antibody; make sure to give Ca gluconate to prevent arrythmia from occurring - potassium binding resin that will bind it and allow for it to be excreted

Question 31

Sulfur | - needed for

Answer 31

- biotin, thiamine, CoA (TCA), antioxidants (glutathione)

Question 32

Mg - needed for - low mg caused by - low mg signs and sxs - tx low Mg - hyper mg

Answer 32

- cofactor for PTH and kinase reactions (cell cycle) - low Ca can be caused by low Mg - Decrease GI absorption (diarrhea) or increased renal loss (diuresis) - torsades de pointes, - Mg SO4 - excessive Mg supplementation or renal failure; decreased DTR, lethargy, paralysis, hypotenson, brady, prologned PR and QT interval; Ca gluconare

Question 33

Cobalt - important for - causes

Answer 33

- Vit B12 -> coBALamine | - contact dermatitis (along with nickel and chromium)

Question 34

Zinc - important for - deficiency - excess

Answer 34

- enzymes and transcription factors - altered mentation, anorexia, diarrhea, impotence, alopecia - suppression of copper and iron absorption bc it uses the same transporter; and can cause permanent loss of sense of smell

Question 35

Molybdenum - used for - deficiency - excess

Answer 35

- xanthine oxidase (purine metabolism into uric acid), other enzymes and part of tooth enamel - esophageal squamous cell carcinoma - diarrhea, infertility, gout

Question 36

Iodine | - needed for

Answer 36

- production of T3 and T4 and T4 to reverse T3

Question 37

Copper - needed for - Menke's syndrome: caused by, sxs, sequlae, tx - Wilsons

Answer 37

- lysine oxidation to form collagen and elastin, and in complex 4 of ETC - deficiency of copper, hair is orange and feels like copper wire; CNS deterioration and failure to thrive; IV copper increases survival but only when started w/i 4 weeks of birth - Auto recessive, excess copper

Question 38

Fluoride - needed for - excess - added

Answer 38

- needed for teeth and bones - excess blocks enzymes in glycolysis - added to water

Question 39

Tin | - used for

Answer 39

- hair growth

Question 40

Manganese | - needed for

Answer 40

- xanthine oxidase (uric acid) and glycolysis pathway

Question 41

Biotin - needed for - deficiency - OTCase

Answer 41

- carboxylations in carb and lipid metabolism - malnutrition, excessive ingestion of raw egg whites (avidin) - needed in order to kick start this enzyme