Vitamin Deficiency's

Question 1

A patient comes into your office with swollen gums, bruising, petechiae, hemearthrosis, poor wound healing, subperiosteal hemorrhages and corkscrew hair. Synthesis of what molecule is being hindered? What vitamin is causing this?

Answer 1

Collagen Synthesis from Vit C deficiency

SCURVY

Question 2

Cobalamin is important in the synthesis of what two things?

Answer 2

Heme (methylmalonyl CoA to Succinyl CoA)

Methionine (from homocysteine)

Question 3

What are the components of riboflavin deficiency?

Answer 3

Cheilosis and Corneal vascularization

Question 4

Vit C main function is in the synthesis of what?

Answer 4

Collagen

Question 5

What TCA reaction will be affected with a deficiency in biotin?

Answer 5

Pyruvate to Oxaloacetate

Question 6

Vit C is necessary for the hydroxylation of what two AA?

Answer 6

Proline and lysine

collagen synthesis

Question 7

What reaction are the cofactors in B2 used for?

Answer 7

Succinate dehydrogenase enzyme in TCA cycle

also imp for glutathione reductase

Question 8

What vitamin is important for the regulation of blood glucose during fasting?

Answer 8

Vit B6 due to it being a cofactor to glycogen phosphorylase used to break down glycogen

Question 9

What neurotransmitters relay on B6 to be made?

Answer 9

Serotonin
Epi
NE
Dopamine
GABA

Question 10

Folate supplement can mask the hematologic symptoms of what deficiency?

Answer 10

B12

Question 11

What vitamin is necessary for the conversion of dopamine to NE?

Answer 11

Vit C

Question 12

What is the difference between wet beriberi and dry beriberi?

Answer 12

Wet beriberi has cardiac failure

Question 13

What organism can cause a decrease in the absorption of Vit C?

Answer 13

Diphyllobothrium Latum

Question 14

What vitamin is required for the production of Cholesterol, Ketone, and fat from acetyl coA?

Answer 14

Biotin or B7 is a cofactor to take acetyl coA to either acetoacetyl CoA (ketones and cholesterol) or Malonyl CoA (fats)

Question 15

What is hartnup disease?

Answer 15

Deficiency of neutral amino acid transporters in proximal renal tubular cells and on enterocytes leading to neutral aminoaciduria and decrease absorption from the gut -> less tryptophan is converted into niacin leading to a deficiency

Question 16

What is Vit D affect in Ca?

Answer 16

Vit D increases the intestinal absorption of calcium and therefore a decrease in Vit D can lead to hypocalcemia

Question 17

Riboflavin is important for the de novo synthesis of what other vitamin?

Answer 17

Niacin from tryptophan

B2 and B6 are used in those reactions

Question 18

What is another name for vitamin B3?

Answer 18

Niacin

Question 19

Increase activation of Vit D by macrophages occurs in what disease?

Answer 19

Granulomatous Diseases

Question 20

A patient is found to have an increase of lactic acid in a blood sample. You note that the same patient has symmetrical muscle wasting and neuropathy. What vitamin is deficient and what enzyme is causing the lactic acidosis?

Answer 20

Thiamine is the Vitamin (TPP the cofactor)

The enzyme is most likely pyruvate dehydrogenase - this enzyme takes pyruvate into the TCA cycle to continue oxidative phosphorylation

Question 21

What test can be done to check for B12 deficiency?

Answer 21

Schilling Test

Question 22

How do you diagnose a deficiency in thiamine?

Answer 22

Give B1 and see if there is an increase in transketolase activity

Question 23

Where is Vitamin D converted to 25, D3

Answer 23

Liver

Question 24

What enzyme deficiency can lead to adrenal insufficiency?

Answer 24

Vit B5 (pentothenic acid)

Question 25

What is a near complication of Vitamin A toxicity?

Answer 25

Pseudotumor cerebri

Question 26

What three other things can cause a deficiency in niacin?

Answer 26

``` Hartnup Disease (deficiency in tryptophan) ``` ``` Carcinoid Syndrome (tryptophan used to make serotonin) ``` Isoniazid (decrease B6 which is needed to make niacin from tryptophan)

Question 27

Propionyl CoA to Methylmalonyl CoA using the enzyme propionyl CoA decarboxylase requires what vitamin?

Answer 27

Biotin | eventually this reaction will regenerate succinyl CoA for TCA cycle

Question 28

Where is vitamin D converted to 1,25 D3

Answer 28

Kidney

Question 29

What three classic drugs can decrease folate?

Answer 29

phenytoin Sulfonamides methotrexate

Question 30

Where is folate absorbed?

Answer 30

Jejunum

Question 31

What vitamin is used as a cofactor in transaminase reactions?

Answer 31

Vit B6 (ALT and AST)

Question 32

PLP is the cofactor of what vitamin?

Answer 32

B6 (pyridoxine)

Question 33

What are the three syndromes that can be caused by a deficiency in thiamine?

Answer 33

Wernicke-Lorsakoff Dry Beriberi Wet Beriberi

Question 34

Patient comes in complaint of tetany and muscle weakness. what vitamin might be deficient?

Answer 34

Vit D

Question 35

What is it called when rickets is caused by a defect in the vitamin D receptor?

Answer 35

Hypophosphatemic Rickets

Question 36

Niacin can be derived from what AA?

Answer 36

Tryptophan

Question 37

What drug is commonly given with B6 to prevent peripheral neuropathy?

Answer 37

Isoniazid

Question 38

How is hypophosphatemic Rickets transmitted?

Answer 38

X DOMINATE

Question 39

Deficiency in pyridoxine can cause what symptoms?

Answer 39

Convulsions, peripheral neuropathy, sideroblastic anemia

Question 40

What cofactor is pentathonic acid?

Answer 40

Coenzyme A

Question 41

Which vitamin is a co-factor for the enzyme alpha ketogluturate?

Answer 41

B1 Thiamine (TPP is the cofactor)

Question 42

What is it called when you have a deficiency in Vit C due to intrinsic factor?

Answer 42

Pernicious Anemia

Question 43

What type of anemia is caused by folate?

Answer 43

Macrocytic megaloblastic anemia with hyperhsegmented polymorphonuclear cells

Question 44

What vitamin is given to children with measles?

Answer 44

Vitamin A

Question 45

dry, scaly skin, corneal degradation, and Bitot Spots are seen in a patient. What is a CI to taking the vitamin that causes these deficiency symptoms?

Answer 45

Pregnancy due to teratogenicity

Question 46

What is the treatment for B1 deficiency?

Answer 46

GIVE B1 then glucose - if you give glucose first you will cause wernicke-korsakoff

Question 47

How can you distinguish the anemia caused by folate and the one caused by cobalamin?

Answer 47

B12 has neuro symptoms

Question 48

What is riboflavin?

Answer 48

Vitamin B2

Question 49

Vitamin A can be used to treat what cancer?

Answer 49

AML | can bind these cells are force them to differentiate

Question 50

Niacin is used to treat what common disorder?

Answer 50

Dyslipidemia

Question 51

Folate is important for the synthesis of what?

Answer 51

Nitrogenous bases in DNA and RNA

Question 52

Why does Pyridoxine deficiency cause anemia?

Answer 52

B6 is used by Delta aminolevulinic acid as the rate limiting step in heme synthesis -> can't make heme then iron gets trapped in the cell and causes sideroblastic anemia

Question 53

What are the symptoms of niacin deficiency?

Answer 53

3 D's | Diarrhea, Dementia, Dermititis

Question 54

Excess niacin leads to what common symptom that can be relieved by ASA?

Answer 54

Flushing

Question 55

Vit C can be used to treat what?

Answer 55

Methemoglobinemia

Question 56

What three regulation factors increase the production of 1.25 OHD3?

Answer 56

Increase in PTH Decrease in Ca Decrease in PO4

Question 57

What are the cofactors of B2?

Answer 57

FAD and FMN

Question 58

What do the labs look like in folate deficiency?

Answer 58

Increase in homocysteine

Question 59

What is another name for Vitamin E?

Answer 59

Tocopherol or tocotrienol

Question 60

What is tocopherol's main function?

Answer 60

Antioxidant (protect RBC and membranes from free radical damage) (Vit E)

Question 61

High does supplement of what vitamin can alter the metabolism of Vit K leading to an enhancing effect of wrfarin?

Answer 61

Vit E

Question 62

What Vitamin deficiency presents with muscle weakness, posterior column and spinocerebellar tract demyelination, and hemolytic anemia but DOES NOT HAVE megaloblastic anemia or hypersegmented neutrophils?

Answer 62

Vit E Deficiency

Question 63

What clotting factors require Vit K?

Answer 63

X, IX, XII, II, protein C and S diSCo 1972

Question 64

What enzyme activated vitamin K?

Answer 64

Epoxide reductase | inhibited by warfarin

Question 65

Vit K is the cofactor for what kind of reaction?

Answer 65

gamma carboxylation of glutamic acid residues on various clotting proteins

Question 66

Who is at risk for a Vit K deficiency?

Answer 66

Neonates (sterile gut flora) Long term Antibiotic patients (gut flora makes Vit K)

Question 67

What will be increases in a patient with a deficiency of Vit K?

Answer 67

PT and aPTT | normal bleeding time

Question 68

Deficiency of what molecule may predispose individuals to alcoholic cirrhosis?

Answer 68

Zinc

Question 69

What molecule is important for the proper folding of proteins?

Answer 69

Zinc

Question 70

Hypogonadism, anosmia, and decrease in adult hair are all symptoms of a deficiency of what molecule?

Answer 70

Zinc

Question 71

What type of protein deficiency does not result in edema?

Answer 71

Marasmus | diet is deficient in calories but no nutrients are entirely absent

Question 72

What is the protein deficiency called that causes edema?

Answer 72

Kwashiorkor

Question 73

What drug inhibits alcohol dehydrogenase?

Answer 73

Fomepizole (antidote for methanol and ethylene glycol overdose)

Question 74

What causes the fatty liver changes in chronic alcohol use?

Answer 74

Increase in NADH favors the production of FA

Question 75

What inhibits acteylaldehyde dehydrogenase and can be used to discourage drinking?

Answer 75

Disulfiram

Question 76

In the setting of chronic alcohol abuse pyruvate is converted to what molecule?

Answer 76

Lactic Acid | disrupts gluconeogenesis

Question 77

In the setting of chronic alcohol use oxaloacntate is converted into what molecule?

Answer 77

Malate | disrupts gluconeogenesis

Question 78

What are the locations of the different enzymes in alcohol metabolism?

Answer 78

Alcohol Dehydrogenase - cytosol Acetylaldehyde Dehydrogenase - mitochondria Catalase - peroxisomes