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Mechanisms of Disease > Nutritional Diseases - Gustafson > Flashcards

Nutritional Diseases - Gustafson Flashcards

1
Q

Primary malnutrition

A

Not enough of a nutrient in the diet to meet the needs of a healthy person

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2
Q

Secondary malnutrition

A

Malabsorption, urinary wasting, or excessive need for a particular nutrient

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3
Q

What is a leading cause of morbidity and mortality?

A

Undernutrition

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4
Q

Most effective cure?

A

Prevention
Good public health measures
Vector control
tons of other shit

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5
Q

Zoonotic disease

A

Jumped into the human species

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6
Q

What are a few diseases that are re-emerging due to climate change?

A

Malaria, dengue fever

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7
Q

What is a poison?

A

Too much of any thing, dosage

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8
Q

Xenobiotics

A

Exogenous chemicals in the environment

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9
Q

What is toxicology?

A

Study of poisons

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10
Q

What do Phase I reactions involve?

A

This is phase I of metabolism of poisons
Hydrolysis
Reduction
Oxidation

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11
Q

What do Phase II reactions involve?

A 
Phase 2 of the metabolism of poisons
Glucuronidation
Sulfation
Methylation
Conjugation
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12
Q

What does carbon monoxide bind to?

A

Hemoglobin

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13
Q

What happen with CO poisoning?

A

Colorless odorless gas, light headiness, confusion, vertigo, mental status changes

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14
Q

What part of parasites (children) susceptible to lead?

A

Brains

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15
Q

Lead in the body does what?

A

Inhibits ferrochelatase, forming ringed sideroblasts, microcytic hypochromic anemia, punctate basophilic stippling of the red cells

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16
Q

Toxicology generally deals with?

A

Substance of abuse, environmental or employment exposure to toxic substances

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17
Q

Is too much of a good thing bad?

A

Yes

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18
Q

Is too little of a good thing bad?

A

Yes

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19
Q

Are we going to be able to answer Gustafson’s questions from left field?

A

Probably not.

But press on, fearless med student, press on.

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20
Q

BMI is an indication of?

A

Nutritional status

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21
Q

What are some things that can lead to too little food/vitamins we need?

A

Poor
Infections
Acute or chronic disease such as cancer or HIV
Improper education about nutrition
Anorexia, bulimia or other psychosocial concerns
Aging and associated chronic conditions

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22
Q

What are 7 lab tests to evaluate nutritional status?

A 
Body weight and height
Ability to perform ADL
BMI
Skin fold thickness
Muscle mass
Albumin
Transferrin
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23
Q

Marasmus

A

Weight 60% below the normal age sex and height voluse
Emaciated appearance to the patient - dry starvation
Deficiency is in total calories
Ravenously hungry
Muscles are wasted, where there is little or no edema

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24
Q

What is deficient in marasmus?

A

Total calories

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25
Q

Kwashiorkor

A 
"wet starvation"
Too little protein in the diet
Low serum albumin --> edema
Fatty liver
Mentally dull
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26
Q

In kwashiorkor where are the protein reserves lost first?

A

Visceral proteins

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27
Q

Is weight normal with marasmus or kwashiorkor?

A

Kwashiokor

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28
Q

What is the flag sign?

A

In Kwashiorkor

Without tyrosine to make melanin, the hair cannot pigment, so becomes stripped

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29
Q

3 Key features of anorexia nervosa?

A

Refusal to maintain a healthy body weight
An intense fear of gaining weight
A distorted body image

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30
Q

What characterizes bulimia nervosa?

A

Frequent episodes of binge eating followed by frantic efforts to avoid gaining weight

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31
Q

4 Fat soluble vitamins are?

A

A D E K

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32
Q

What are the 9 water soluble vitamins?

A 
Vit B1 - thiamine
Vit B2 - riboflavin
Vit B6
Vit B12
Niacin
Vit C
Folate
Pantothenic acid
Biotin
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33
Q

Vit A important for what two things?

A

Phototransduction

Maintenance of epithelial differentiation

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34
Q

Too little Vit A

A

Squamous metaplasia/hypkeratosis

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35
Q

Too much Vit A

A

De-differentiation of squamous epithelium

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36
Q

What cause lead to Vit A deficiency?

A

Poverty
Fat malabsorption - intestinal or biliary obstruction
Weird diets
Amateur vegetarians
-more common in poor nations, can combat by giving supplement every 6 months

37
Q

Bitot’s spots

A

Extra keratin on the eye

38
Q

Squamous metaplasia of the eye causes

A

Xerophthalmia - dry eyes

39
Q

Vit A deficiency leads to?

A

Night blindness because retinal rod pigments can’t be renewed
Squamous metaplasia of columnar epithelia in airways and urothelium - makes respiratory inf, esp measles more of a problem and cited as cause of an increased rate of kidney stones

40
Q

If you eat polar bear liver what can happen?

A
  1. You can get your ass thrown in a psych ward for being a freak
  2. Vit A toxicity
41
Q

Can you eat so many carrots that you overdose on Vit A?

A

Nope

42
Q

Pts who have Vit A toxicity present with?

A

Increased intracranial pressure

43
Q

Two common def with Vit D?

A

Rickets in children

Osteomalacia in adults

44
Q

What does costochondral junction in vit D def look like?

A

New osteoid does not calcify well, chondrocytes don’t line up normally

45
Q

Best dietary sources of Vit D?

A

Enriched dairy products
Oily fish - mackerel (mmmmm)
Shiitake mushrooms grown under UV light

46
Q 
Levels of 25-hydroxyvitamin D
Toxic?
Normal?
PTH elevated and treat?
WHO says deficient?
A

150 ng/dL
80 ng/dL
30-40

47
Q

What kind of idiots overdose on Vit D? What can they develop?

A

Those that abuse supplements

Kidney stones

48
Q

2 pts with Vit E deficiency?

A

Preemies

Pts with fat malabsorption

49
Q

What problems did preemies have that we overcame with Vit E supplementation?

A

Hemolytic disease

50
Q

What does Vit K allow us to do?

A

g-carboxylation of glutamic acid to make clotting factors II, VII, IX, X, C and S

51
Q

What causes Vit K deficiency

A

Preemies
Babies generally - esp milk only babies
Fat malabsorption
Functional def - liver failure, coumadin Rx

52
Q

Are anti-vaxxers smart folk?

A

Fuck. No

53
Q

What can happen if 100 anti-vaxxers refuse the vit K injection for their baby after birth?

A

1 of them will have a brain hemorrhage from Vit K def

PVL - periventricular leukomalacia

54
Q

What can cause Vit B1 (thiamine) def?

A

Crackpot diets
Starvation/alcoholic binge
After bariatric surgery

55
Q

If you give a glucose IV to someone who’s thiamine deficient, you can ppt what?

A

Wernicke’s

56
Q

Korsakoff’s

A

Thiamine def in young children

57
Q

What can cause Vit B3 (niacin)?

A

Dietary - poverty, monotonous grain based diet, alcoholism, anorexia
Others - carcinoid tumors, malabsorption, taking isoniazid, hartnup disease

58
Q

What is Pellagra? What is it from?

A 
From niacin (B3) def
Starts as a sunburn-like rash, then becomes a flaky, hyper pigmented rash esp where there's sun exposure
59
Q

What are the 4 D’s of pellagra?

A

Dermatitia, diarrhea, dementia (psychoses), death

60
Q

When is pantothenic acid (B5) def seen? 1 symptom?

A

Mixed deficiencies in wartime/famine

Painful paresthesias in lower legs - burning feet

61
Q

What does Vit B6 (pyridoxine) do?

A

Shuttles amino groups

62
Q

When are Vit B6 levels low?

A

non-supplementing vegetarians

63
Q

When is Folic acid (Vit B9) low? What does it do?

A

Shuttles methyl groups

Junk food diet, alcoholics, pregnancy, phenytoin users, malabsorption

64
Q

Folic acid famously causes?

A

Megaloblastic anemia

65
Q

Folic acid supplementation can help with?

A

NTDs

Cleft palate/lip

66
Q

What is Vit C important for? Def called?

A

Is the oxidizer to maintain collagen

Scurvy

67
Q

What causes scurvy?

A 
Lack of Vit C
-long sea voyages
poverty
crackpot diets
alcoholic binges
some dialysis pts
68
Q

What is a scurvy rash?

A

Petechiae around hair follicles

Coiled corkscrew hairs

69
Q

Why is scurvy painful?

A

First arthralgia and joint effusions

Then bleeds, including under periosteum

70
Q

What major things cause iron def?

A

Diet - non-meat-eaters, milk only babies
Extra need - menses, preggo, blood donors
Those with GI/GU bleeds
Malabsorption - esp celiacs

71
Q

What is the most commonly detected nutritional problem in US today?

A

Iron def

72
Q

What can cause hypchromic, microcytic anemia?

A

Iron def

73
Q

Koilonychia

A

Wavy nails

from iron def?

74
Q

What is zinc required for?

A

Basic enzymes like carbonic anyhdrase and alk phis. Animal proteins most abundant, breast milk is low

75
Q

Acrodermatitis enteropathica

A

Dermatitis around mouth and anus and on extremities
With thinning of the hair and diarrhea
Assoc with zinc def
Manage with high doses of oral zinc

76
Q

Copper def? Associated with?

A

Preemies, starvation, zinc enthusiasts

Anemia, body deformities (if long standing in kids) and depigmentation

77
Q

Mencke’s disease

A

Kinky hair

Inborn error of metabolism

78
Q

Keshan disease

A

Selenium def

In 1969 bureaucrat forgot to add selenium to the fertilizer, making more hearts vulnerable to coxsackievirus

79
Q

What do we need iodine for?

A

Lots of shit

But also to make thyroid hormone

80
Q

Number one cause of preventable mental retardation worldwide?

A

Iodine def

81
Q

Iodine def goiters

A

The thyroid gland undergoes hyperplasia under the influence of high hTSH

82
Q

Magnesium def

A

Not enough green in your diet

Not clear if there is a def

83
Q

Obesity

A

Increased body fat, excess body weight

84
Q

Overweight BMI

A

25-30

85
Q

Obese BMI

A

> 30

86
Q

Leptin

A

Tells up to stop eating

87
Q

What is the fat burner that guards against obesity

A

Adiponectin

88
Q

Consequences of obesity

A

Type II DM, insulin resistance and hyperinsulinemia

Mechanisms of Disease (8 decks)

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