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USMLE Step 1 > Vitamins and Minerals > Flashcards

Vitamins and Minerals Flashcards

1
Q

Houses built before this year have a higher chance of having lead-based paint:

A

1978

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2
Q

What two enzymes does lead inhibit?

What is the overall effect of this inhibition?

A

Ferrochelatase
ALA dehydratase
Decrease in heme synthesis

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3
Q

Lead poisoning, in addition to decreasing heme synthesis, also inhibits another important cellular process. What histologic finding is caused by this failure?

A

Lead –| rRNA degradation

Basophilic stippling in RBC, the spots are retained clumps of rRNA

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4
Q

What are Burton’s lines?

Where might you find a related finding?

A

Lead lines on gingivae.

Lead deposited where new collagen is being built, may see it in the metaphyses of long bones.

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5
Q

Six common findings in long-term lead poisoning:

A 
LEEAAD:
Lead lines (gingivae, long bones)
Encephalopathy
Erythrocytes -- basophilic stippling
Abdominal colic (low heme synthesis)
Anemia (sideroblastic)
Drops -- foot and wrist
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6
Q

What is the treatment for lead poisoning in adults?

In children with severe poisoning, you may want to consider addding this medication:

A

Succimer + EDTA

Kids w/ severe = add dimercaprol

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7
Q

Four early signs of lead poisoning:

A

Drop in IQ
Hearing problems
Impaired growth
Wrist drop / foot drop

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8
Q

Where does mercury accumulate (2):

A

Kidney

Brain

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9
Q

Two main signs of mercury poisoning:

A

Abdominal pain

Acrodynia

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10
Q

What is acrodynia? What two disease processes might you see it in?

A

Acrodynia = peeling of fingertips

May see with Kawasaki or mercury poisoning

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11
Q

What happens in acute arsenic poisoning?

A

Multisystem organ failure

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12
Q

Arsenic is primarily toxic to the (3):

A

GI system, CNS, and CV system

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13
Q

Cadmium is toxic to the (3):

A

Lung, kidney, and bone

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14
Q

Two bone diseases associated with cadmium toxicity:

A

Osteoporosis

Osteomalacia

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15
Q

Four famous correlates to hypercalcemia:

A

Stones
Bones
Groans (abdominal)
Psychiatric overtones

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16
Q

What is Trousseau’s sign? What does it indicate?

A

Tighten BP cuff -> carpopedal spasm

Indicates hypercalcemia

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17
Q

What is Chvostek’s sign? What does it indicate?

A

Tap the CHeek -> facial spasm

Indicates hypercalcemia

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18
Q

What metal is necessary for the function of these enzymes?
Lactate dehydrogenase
Carbonic anhydrase

A

Zn

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19
Q

Consider supplementing this metal in burn patients:

A

Zn

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20
Q

What is acrodermatitis enteropathica? Mineral deficiency assoicated with this?

A

Rash around mouth, eyes, nose, and anus.

Associated w/ Zn deficiency

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21
Q

Zinc deficiency, common presenting signs / sx (6):

A 
Delayed wound healing
Impaired night vision
Hypogonadism / infertility
Hair loss in adults
Acrodermatitis enteropathica
Anosmia
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22
Q

Cell storage protein for iron:

This protein is ferric acid + ________.

A

Ferritin = ferric acid + apo ferritin

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23
Q

Two ways in which iron poisons cells:

A

Peroxidates membranes

Generates free radicals

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24
Q

Iron is stored in these three organs primarily:

A

Liver, spleen, bone marrow

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25
Q

Iron transport protein:

A

Transferrin

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26
Q

Half-life of transferrin:

A

8d

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27
Q

Early symptoms of iron poisoning:

A

Gastric bleeding
(Hematemasis
Abdominal pain, possible
Hypovolemic shock)

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28
Q

Abnormality on blood gas seen 6-72hr out from iron overdose:

A

Metabolic acidosis

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29
Q

2-8w out from an iron overdose, you might commonly observe this finding:

A

Scarring of the GI tract

Possible GI obstruction

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30
Q

Enzymes involved in Hb synthesis that are inhibited by lead poisoning (2):

A

Ferrochelatase

ALA dehydratase

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31
Q

Four major functions of Vitamin C:

A

Antioxidant
Helps Fe transport (keeps it reduced)
Hydroxylates lysine and proline in collagen synth.
Dopamine-b-hydroxylase (DA -> NE)

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32
Q

This enzyme converts DA to NE:

This co-factor is required for this enzyme:

A

Dopamine b-hydroxylase

Vitamin C

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33
Q

In collagen synthesis, vitamin C hydroxylates these two residues:

A

Proline, lysine

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34
Q

How does vitamin D work to increase calcium absorption from the gut?

A

It increases calcium binding protein levels

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35
Q

The form of vitamin D found in plants (2 names):

A

Ergocalciferol

Vitamin D2

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36
Q

The form of vitamin D made when sun hits your skin (2 names):

A

Cholecalciferol

Vitamin D3

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37
Q

This form of vitamin D is made from cholecalciferol and is converted to the active form of vitamin D:

A

25-OH cholecalciferol =

Calcidiol

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38
Q

Two scenarios you might see vitamin D toxicity:

A 
Excess supplementation (hard to do)
Sarcoidosis (macrophages can convert calcidiol into calcitriol)
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39
Q

Active form of vitamin D:

A

1,25-dihydrocholecalciferol =

calcitriol

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40
Q

This enzyme is responsible for making the active form of vitamin D:

A

1-a-hydroxylase

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41
Q

Lack of this enzyme is the reason renal patients don’t make much active vitamin D:

A

1-a-hydroxylase

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42
Q

The other name for vitamin E:

A

Tocopherol

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43
Q

Cause of autosomal recessive vitamin E deficiency:

A

a-tocopherol transport protein mutation

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44
Q

Fragile RBCs, ataxia, and muscle weakness, what enzyme am I?

A

Vitamin E = a-tocopherol

45
Q

Where is vitamin K made?

A

In the gut, by gut flora.

46
Q

Three common medications / classes of meds that can cause vitamin K deficiency:

A

Abx
Anti-convulsants
Warfarin

47
Q

Neonate with high PT and aPTT but normal bleeding time:

A

Vitamin K deficiency

48
Q

Two functions of vitamin K:

A

Bone mineralization

g-carboxylation of glutamic acid on proteins used in the clotting cascade (II, VII, IX, X, C, S)

49
Q

Uses of topical vitamin A (3):

A

Wrinkles
Psoriasis
Acne

50
Q

Two diseases oral vitamin A can be used to mitigate:

A

Measles

AML, type M3

51
Q

Corneal ulcers, want to r /o:

A

Vitamin A deficiency

52
Q

What are Bitot’s spots?

A

Dry silver plaques on conjunctiva, seen in vitamin A deficiency

53
Q

Night blindless, dry skin:

A

Vitamin A deficiency

54
Q

Protein that transports vitamin A:

A

Retinol binding protein

55
Q

T/F: Retinoic acid is usable by the body:

A

F.
b-carotene -> retinol = usable by the body
retinal = usable by the body

56
Q

Pseudotumor cerebri, liver enlargement, dry skin, pruritis:

A

Vitamin A toxicity

57
Q

Hypercalcemia, appetite loss, stupor:

A

Vitamin D toxicity

58
Q

Organ that adds the first OH group to cholecalciferol?

Where is the second group added?

A

Liver

Kidney. Requires 1-a-hydroxylase.

59
Q

Dermatitis, glossitis, diarrhea:

A

B-complex deficiencies

60
Q

Thiamine is a.k.a:

A

Vitamin B1

61
Q

Thiamine deficiency (3):

A

Impaired glucose breakdown (deficiency made worse on glucose ingestion, thiamine needed for pyruvate dehydrogenase, a-ketoglutarate dehydrogenase, transketolase)
Wernicke-Korsakoff
Beriberi

62
Q

This vitamin is involved in decarboxylation reactions and heavily involved in the TCA cycle:

A

Vitamin B1 =

Thiamine

63
Q

Cheilosis, dermatitis, glossitis:

A

Vitamin B2 deficiency =

Riboflavin

64
Q

What two molecules are derived from vitamin B2?

A

B2 = riboflavin

FAD / FMN are derived from riboflavin

65
Q

Vitamin B3 derives from this amino acid:

A

Tryptophan

66
Q

Diarrhea, dermatitis, dementia:

A

Pellagra

Niacin = vitamin B3 deficiency

67
Q

What effect does niacin have on cholesterol?

A

Increases HDL

68
Q

Symptoms of excess niacin:

A

Facial flushing

mitigate with ASA if using niacin to tx HL

69
Q

Malignant carcinoid syndrome, diarrhea, dementia:

A

Pellagra associated with B6 deficiency

70
Q

Dermatitis, alopecia, adrenal insufficiency:

A

Vitamin B5 deficiency

71
Q

Other name for vitamin B5:

A

Pantothenate

72
Q

This vitamin is used in transamination reactions:

A

Vitamin B6 =

Pyridoxine

73
Q

This vitamin is necessary for the synthesis of very many neurotransmitters:

A

Vitamin B6 =

Pyridoxine

74
Q

Convulsions, hyper-irritability, peripheral neuropathy:

A

Vitamin B6 deficiency

Remember B6 is needed in neurotransmitter synth.

75
Q

Cofactor for carboxylation reactions:

A

Vitamin B7

Biotin

76
Q

Macrocytic, megaloblastic anemia w/o neurologic symptoms:

Macrocytic megaloblastic anemia w/ neurologic symptoms:

A

Vitamin B9 deficiency = folic acid

Vitamin B12 deficiency = cobolamin

77
Q

Subacute combined degeneration:

A

Vitamin B12 = cobolamin deficiency

78
Q

Most common cause of vitamin B12 deficiency:

A

Lack of intrinsic factor, this is most commonly autoimmune

79
Q

Convulsions and irritability: What vitamin deficiency am I?

A

Vitamin B6 = pyridoxine

causes “paroxysms”

80
Q

Which vitamin deficiency am I? Increased RBC fragility:

81
Q

Which vitamin deficiency am I? Peripheral neuropathy, glossitis:

A

Vitamin B12

82
Q

Which vitamin deficiency am I? Dermatitis, diarrhea, dementia:

A

D3 for the 3Ds

Niacin

83
Q

Which vitamin deficiency am I? Megaloblastic anemia:

A

B12 or B9 (folate)

84
Q

Which vitamin deficiency am I? Bitot spots, keratomalacia, xerophthalmia:

85
Q

This vitamin can be used to treat acne and psoriasis:

86
Q

This vitamin is used in redox reactions (2):

A 
B2 = riboflavin
B3 = niacin
87
Q

This vitamin is used in carboxylation reactions:

88
Q

This vitamin can be used to elevate HDL and decrease LDL cholesterol:

A

Vitamin B3 = niacin

89
Q

Deficiency in this vitamin can be caused by isoniazid use:

A

Vitamin B6 = pyridoxine

90
Q

These vitamins are critical for DNA synthesis (2):

A

Folate

B12

91
Q

Thiamine =

92
Q

Retinol / retinal =

93
Q

Pantothenic acid =

94
Q

Pyridoxine =

95
Q

a-tocopherol =

96
Q

Folic acid =

A

Vitamin B9

97
Q

Niacin =

A

Vitamin B3

98
Q

Riboflavin =

A

Vitamin B2

99
Q

Ascorbic acid =

100
Q

Cobalamin =

A

Vitamin B12

101
Q

B1 =

102
Q

B5 =

A

Pantothenic acid

103
Q

B6 =

A

Pyridoxine

104
Q

B9 =

A

Folic acid

105
Q

B3 =

106
Q

B2 =

A

Riboflavin

107
Q

B12 =

108
Q

These two water-soluble vitamins are stored in the liver:

A

B12 (cobolamin)

Folate (B9)

109
Q

You ate a polar bear liver and got vitamin A poisoning. Can you think of four clinical manifestations?

A

Headache
Pseudotumor cerebri
Liver enlargement
Skin changes (dry, pruritic skin)

USMLE Step 1 (18 decks)

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