Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Systemic Disease (Wolfe) > Nutritional and Toxicity > Flashcards

Nutritional and Toxicity Flashcards

1
Q

When is AREDS useful?

A

moderate to late stage AMD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What effect does AREDS supplementation have?

A

25% risk reduction of progression to advanced AMD; or 20% risk reduction over 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What was the probability of progression to advanced AMD with placebo vs antioxidants + zinc?

A

placebo 28% and antioxidant + zinc 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is category 1 from the original AREDS study?

A

no AMD or small drusen <63 um or drusen collectively < 120 um

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is category 3 from the original AREDS study?

A

concern intermediate drusen < 125 um = 1/2 diameter of retinal vessel at ONH per Dr. Wolfe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When should you start AREDS supplementation based on category?

A

category 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is category 4 from the original AREDS study?

A

wet AMD in one eye w/ any stage of AMD in the fellow eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Drusen vs RPE drop out

A

drusen have shadow around it since it’s sub-RPE while RPE dropout is sharply demarcated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

With drusen in one eye and geographic atrophy in the other, do you recommend AREDS?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When is it hard to visualize geographic atrophy?

A

with blonde fundus, utilize AF or red-free

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

With geographic atrophy in both eyes do you recommend AREDS?

A

No, refer to low vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What color is a sub-retinal heme?

A

gray-green per Dr. Wolfe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What color is the breakthrough heme?

A

red

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What technology should you order with a sub-retinal heme?

A

OCT and IVFA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

With drusen in one eye and unremarkable findings in the other do you recommend AREDS?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the difference between AREDS 1 and 2?

A

2 removed vit A and added lutein and zeaxanthin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is culinary medicine?

A

evidence-based field in medicine that blends the art of food and cooking with the science of medicine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the goal of culinary medicine?

A

help people reach good personal medical decisions about accessing and eating high-quality meals that help prevent and treat disease and restore well-being

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Culinary medicine does not..

A

have a single dietary philosophy, reject prescription medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What might an anti-inflammatory diet be good for?

A

rheumatologic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a ketogenic diet good for?

A

neurological disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is a mediterranean diet good for?

A

cardiovascular and metabolic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What condition is legumes good for?

A

hyperlipidemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What condition is soy nuts good for?

A

hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What condition are tree nuts good for?

A

metabolic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What condition is baked fish good for?

A

heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What condition is honey and milk good for?

A

acute cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What was the first medical school with culinary medicine?

A

Tulane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What 2 genes are associated with AMD?

A

CFH and ARMS2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is CFH?

A

a gene dealing with complement and immune response/inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is ARMS2?

A

a gene dealing with oxidative stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is a healthy diet for prevention of AMD?

A

carotenoids, fish and nuts, supplements, normal weight, no smoking, exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

High total fat intake leads to

A

3 fold higher risk for progression of AMD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

High saturated and trans fat leads to

A

2 fold increase in AMD progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

High Omega 3 leads to

A

reduced AMD progression by 25-40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What were the nutritional differences between the discordant twins?

A

lower intake of vit D, betaine and methionine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

T/F omega 3 intake is associated with lower risk of progression to geographic atrophy

A

true, mostly in those with ARMS2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is a mediterranean diet and when is it beneficial?

A

high intake omega 3 and low saturated fats, benefit if one non-risk CFH allele (no benefit for CFH homozygous risk genotype

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

T/F vitamin D intake had significantly lower risk of progression

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

When does AREDS hurt you?

A

patients with high CFH and no ARMS2 risk alleles increased progression to NV compared to placebo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

When does AREDS help you?

A

those with low CFH and high ARMS2 risk had decreased risk of progression with AREDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

T/F vitamins are cofactors (coenzymes) essential for many biochemical reactions necessary for cell survival

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How many vitamins are universally recognized?

A

13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are vitamins classified based on?

A

biological and chemical activity (function), not structure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Where are water-soluble vitamins stored?

A

not stored in the body, can be depleted within a number of days during starvation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Where are fat-soluble vitamins stored?

A

carried in fat and stored in liver, excess storage may lead to toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are water-soluble vitamins?

A

Bs, C, and folic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are fat-soluble vitamins?

A

ADEK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is vitamin A?

A

retinol, fat soluble, found in animal products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the vitamin A vitamer compounds?

A

retinol, retinal, and four carotenoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the precursor for vitamin A in carrots and other orange vegetables?

A

beta-carotene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are vitamin A roles?

A

develop and maintain epithelial tissue, component of goblet cells, prevents keratinization and squamous metaplasia by controlling rate of ocular surface cell proliferation and differentiation, antioxidant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Where ocularly is vitamin A stored?

A

within the lacrimal gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How is vitamin A secreted from the lacrimal gland?

A

reflexively through aqueous layer of the tear film as all trans-retinol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

T/F vitamin A is an antioxidant

A

true, but studies show carotenoids may undergo oxidation leaving byproducts in the lungs and arterial blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Vitamin A and smoking

A

caused oxidative damage and tumor growth in smokers and those exposed to second-hand smoke; vit A removed after AREDS 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are free radical examples?

A

superoxide, peroxide, singlet oxygen and hydroxyl radicals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Where are free radicals found?

A

in tissues with high metabolic demands ex: lens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What cell produces oxygen species as a defense?

A

neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

T/F free radicals are in hypoxic or hyperoxic cellular conditions

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How do antioxidants help?

A

donate an electron to free radicals neutralizing it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

3 additional functions of vitamin A

A

mediator for gene transcription, component in bone metabolism and hematopoiesis, component of rhodopsin and iodopsin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What are visual pigments made of?

A

opsin (membrane apoprotein) + chromophore (11-cis retinal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Where is vitamin A oxidized?

A

diffuses through the choriocapillaris to the RPE where it is oxidized to 11-cis retinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What happens when 11-cis retinal absorbs a photon of light?

A

phototransduction is initiated

66
Q

Vitamin A deficiency causes

A

inadequate intake, fat malabsorption or liver disorders

67
Q

What is recommended daily dose of Vitamin A?

A

900 micrograms aka 3000 IU for men and 700 micrograms aka 2300 IU for women

68
Q

Systemic vitamin A deficiency

A

immunity impairment, impairment to hematopoiesis with potential for anemia, rash

69
Q

What is a major cause of blindness in underdeveloped countries?

A

vitamin A deficiency

70
Q

What is xerophthalmia?

A

cornea and conjunctiva become keratinized from excessive dryness

71
Q

What are signs of xerophthalmia?

A

conj looseness, folds, pigmentation, decreased luster, poor wetting, mucin-secreting goblet cells affected

72
Q

What is nyctalopia?

A

night blindness from vitamin A deficiency, rods affected before cones

73
Q

What is an initial sign of nyctalopia?

A

lengthened dark adaptation time, once cones are affected: loss of central acuity and color vision

74
Q

What is a bitot’s spot?

A

clump of keratin debris within the conjunctiva as a result from dryness

75
Q

What is keratomalacia?

A

secondary to chronic dryness that leads to necrosis and ulceration of the cornea, need corneal graft surgery

76
Q

T/F a severely dry cornea can perforate w/in 24 hours

A

true

77
Q

Vitamin A excess systemically

A

dizziness, HA, hypercalcemia, liver damage, nausea, hair loss, oily skin, joint pain, sore throat, yellow discoloration of the skin (aurantiasis cutis)

78
Q

Vitamin A excess ocularly

A

blurred vision, diplopia, nystagmus, nerve palsies, papilledema

79
Q

What is vitamin C?

A

ascorbic acid, water soluble, must be ingested, potent antioxidant

80
Q

What vitamin is a cofactor in collagen synthesis?

A

vitamin C

81
Q

Functions of vitamin C

A

formation of connective tissue, protect capillaries, minimizing hemorrhages, enhances iron absorption, promotes wound healing, healthy gums/teeth/bones

82
Q

Why do you want good collagen in Bruch’s?

A

prevent formation of drusen

83
Q

What vitamin does vitamin C recycle?

A

E

84
Q

Where is the highest concentration of vitamin C found in food?

A

citrus fruits, green vegetables, tomatoes, potatoes, cantaloupe

85
Q

What are early systemic signs of vitamin C deficiency?

A

bruising, petechial hemorrhages, weakened hair or nails, low resistance to infection

86
Q

What are advanced signs of vitamin C deficiency?

A

scurvy: collagen defects, impaired healing, bleeding into joints, swollen and bleeding gums, impaired digestion, brittle bones, psychological changes

87
Q

What can decreased vitamin C intake result in?

A

anemia, decreased ability to fight infection, decreased wound healing rate, swollen painful joints, weakened tooth enamel

88
Q

What are ocular signs of vitamin C deficiency?

A

hemorrhagic conjunctivitis, petechial hemorrhages, hyphema

89
Q

What is vitamin E?

A

fat soluble, antioxidant, must be absorbed from diet

90
Q

What is the least toxic vitamin?

A

E

91
Q

What vitamin protects vitamin A?

A

E

92
Q

What is the role of vitamin E?

A

critical in cell membranes, boosts immune system, widens blood vessels/reduces thrombin formation, reproductive/neurologic/muscular systems

93
Q

What medication should you be careful with when taking vitamin E?

A

anticoagulants like Warfarin

94
Q

What foods contain vitamin E?

A

vegetable oils, nuts, seeds, and green leafy veggies

95
Q

What disease is vitamin E deficiency linked to?

A

diseases where fat is not properly digested or store, ex: crohn’s disease, cystic fibrosis, genetic disease like abetalipoproteinemia

96
Q

T/F vitamin E deficiency is more common in premature babies

A

true, low plasma levels of vitamin E leading to levels decreasing rapidly due to lack of adipose tissue

97
Q

What is the recommended dietary allowance of vitamin E?

A

15 mg/day for adults

98
Q

What are signs of ocular vitamin E deficiency?

A

night blindness (vit A not protected), lipofuscin formation, drusen, increased risk for AMD, lens opacification

99
Q

What is lipofuscin?

A

waste product when rods/cones die; forms within RPE cell, damaging the RPE cell membrane

100
Q

What is zinc for?

A

antioxidant; metabolism of nucleic acids, proteins, carbs, alcohol; required for DNA/RNA synthesis and vitamin A use

101
Q

What mineral is used in axoplasmic flow throughout neurons?

A

zinc

102
Q

What are sources for zinc?

A

milk, eggs, poultry, seafood, red meat, onions, peas, soybeans, mushrooms, whole grains, nuts, seeds

103
Q

What are systemic signs of zinc deficiency?

A

lack of taste or smell, dry irritated skin, poor appetite, fatigue, infections, hypogonadism, loss of hair, slow growth, problems with wound healing

104
Q

What are systemic signs of excess zinc?

A

diarrhea, abdominal cramps, vomiting

105
Q

What are ocular signs of zinc deficiency?

A

AMD, optic neuropathy, symptoms of vit A deficiency, low IOP

106
Q

T/F zinc metabolizes retinal byproducts by the RPE cells

A

true

107
Q

How can zinc deficiency optic neuropathy occur?

A

many drugs are zinc chelators

108
Q

Why might you have symptoms of vit A deficiency with a zinc deficiency?

A

zinc metabolizes vit A, maintains normal serum vit A by mobilizing it from liver, transforms retinol to retinaldehyde for use by rods

109
Q

How are IOP and zinc related?

A

zinc involved in aqueous production, coenzyme of carbonic anhydrase

110
Q

Why was copper added to the AREDS formula?

A

zinc chelates copper, so copper was added to replenish the copper supply

111
Q

How many naturally occurring carotenoids are there?

A

600, ~50 in a western diet, and 14 in vivo (human serum)

112
Q

Macular pigment is the collective name for…

A

isomeric carotenoids lutein and zeaxanthin

113
Q

T/F carotenoids are accumulated within the sensory retina at levels 1000x higher than found in serum to the exclusion of all other carotenoids

A

true

114
Q

What factors affect serum levels of carotenoids?

A

serum level decreased by body fat, oxidative stress/smoking, female gender, dietary fat

115
Q

What are carotenoids transported on?

A

circulating lipoproteins, slightly higher affinity for HDL

116
Q

What are the 3 theories of carotenoids?

A

optical, protection and neuro efficiency

117
Q

What is the optical hypothesis of carotenoids?

A

halo found around fovea because it absorbs stray blue light that gives you clarity of vision

118
Q

What is the protection hypothesis of carotenoids?

A

reduces oxidative stress, carotenoids span the lipid bilayer and help maintain structure and integrity of the cell membrane

119
Q

What is the neuro efficiency hypothesis of carotenoids?

A

unknown moa

120
Q

What does research on mediterranean diet and AMD show?

A

no significant association with early AMD, but associated with reduced odds of neovascular AMD

121
Q

What are 2 main nutritional optic atrophy etiologies?

A

excess vitamin A and avitaminosis B

122
Q

What is ethambutol etiology?

A

toxic optic neuropathy that is dose dependent and duration related, chelating properties, symptoms appear 4 months- 1 year, 25 mg/kg/d, test color vision

123
Q

What is isoniazid etiology?

A

toxic optic neuropathy, higher risk with hepatic or renal disease, vision loss, central or cecocentral scotoma, dyschromatopsias

124
Q

What is amiodarone etiology?

A

treatment for arrhythmias, unclear moa maybe lipidosis, insidious visual loss, bilateral, persistent ONH edema

125
Q

B Vitamin overview

A

water soluble, cannot be stored in the body, important role in cell metabolism, rarely leads to toxicity

126
Q

What is the role of b1?

A

thiamine, co-enzyme that converts carbohydrates into glucose, used in heart muscle digestion and nervous sytem, synthesis of acetylcholine

127
Q

What are sources of b1?

A

whole grain cereals, beans, nuts, peas, oranges, brewer’s yeast

128
Q

Where is b1 deficiency endemic?

A

east asia, due to large consumption of refined white rice

129
Q

Who gets b1 deficiencies?

A

poor dietary intake, alcoholics, institutionalized, GI syndromes

130
Q

What are signs of early b1 deficiency?

A

impaired digestion of carbs and constipation

131
Q

What are signs of chronic b1 (thiamine) deficiency?

A

beriberi, wernicke encephalopathy, Korsakoff’s psychosis, death

132
Q

What is beriberi?

A

anorexia, cardiac enlargement, tachycardia, muscular weakness, ataxia, paresthesia , dyspnea upon exertion

133
Q

What is Wernicke encephalopathy?

A

severe, acute deficiency, chronic alcoholism or malnutrition, dementia, ataxia, ophthalmoplegia with nystagmus, mild confusion to coma

134
Q

What is Korsakoff’s psychosis?

A

cerebral cortex damage

135
Q

What are ocular signs of deficiency of b1?

A

restricted EOM motility, anterior or retrobulbar optic neuropathy, nystagmus, toxic optic neuropathy, ophthalmoplegia

136
Q

What is vitamin b2 for?

A

riboflavin, essential for metabolism of carbs, fatty acids and amino acids; tissue repair, formation of antibodies, mucous membranes, enhancing efficacy of vitamin D,

137
Q

Who gets deficiencies of b2?

A

low socioeconomic status, elderly recluse, alcoholic, oral contraceptive and diuretic use, hemodialysis, processed foods, exposure to UV light, stressed

138
Q

What are sources of b2?

A

milk, whole grain cereals, daily, liver, beef, eggs

139
Q

What are signs of systemic deficiency of b2?

A

rare, nonfatal symptoms after 3-4 months, angular stomatitis, seborrheic dermatitis, glossitis

140
Q

What are signs of ocular deficiency of b2?

A

conj injection, corneal vascularization, keratitis sicca, SPK, interstitial infiltrates, ulceration, decreased light adaptation, cataracts

141
Q

What are 3 ocular conditions from low b2?

A

phlyctenular keratoconjunctivits, rosacea keratitis, angular blepharoconjunctivitis

142
Q

What are two things that cause angular blepharoconjunctivitis?

A

vitamin b2 deficiency and moraxella infection

143
Q

What is the treatment of vit b2 deficiency?

A

single IM injection or daily oral dose until resolution, maintenance doses

144
Q

What is vit b3?

A

niacin, coenzyme for oxidoreductase, used for carbohydrate/amino acid/lipid metabolism, able to synthesize in vivo from tryptophan

145
Q

What are sources of b3?

A

brewer’s yeast, meats, brain, liver, legumes, corn

146
Q

What is a chronic deficiency of b3?

A

pellagra– skin lesions, diarrhea, dementia

147
Q

What are signs of b3 excess?

A

elevated HDL levels, niacin flush, niacin maculopathy (1-3 g)

148
Q

What are functions of b6?

A

pyridoxine, amino acid metabolism, synthesis of neurotransmitter (serotonin, melatonin, dopamine, NE, GABA)

149
Q

What are sources of b6?

A

high protein: meats, nuts, whole grains, cabbage, peas, bananas, pears

150
Q

What are ocular b6 deficiencies?

A

gyrate atrophy, seborrheic dermatosis, angular blepharoconjunctivitis

151
Q

What is vitamin b12?

A

cobalamin, synthesized by microorganisms in fermented foods, absorbed with intrinsic factor

152
Q

What are functions of vitamin b12?

A

active in all cells, essential for cellular replication, bone marrow and GI tract; metabolism of folate, myelin sheath formation, DNA synthesis

153
Q

What are sources of b12?

A

meat (liver)

154
Q

What deficiency are vegans at a higher risk for?

A

b12

155
Q

T/F a gastrectomy can lead to deficiency in b12

A

true

156
Q

What are systemic signs of deficiency of b12?

A

pernicious anemia, neurological dysfunction

157
Q

What is pernicious anemia?

A

macrocytic normochromic, characterized by megaloblastic anemia (impaired DNA synthesis) + folate deficiency

158
Q

What are ocular signs of b12 deficiency?

A

can precede systemic findings, hemorrhages, CW spots, tortuous blood vessels, ON damage, palor or neuropathy

159
Q

What is treatment of b12 deficiency?

A

enhanced diet/supplements, increase iron and folic acid intake; b12 injections w/ pernicious anemia

160
Q

What is treatment of b12 deficiency if optic neuropathy present?

A

supplement entire b complex not just b12

161
Q

Why is temporal pallor often first?

A

propensity for papulomacular bundle since most metabolically active

162
Q

What is the acronym for optic neuritis involvement?

A

VIN DITTCH, MD

Systemic Disease (Wolfe) (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions