Vitamins & Minerals

Question 1

Cause of death in Iron poisoning

Answer 1

Cell death due to peroxidation of membrane lipids

Question 2

Treatment for Iron poisoning

Answer 2

Chelation! = IV deferoxamine, oral deferasirox

Dialysis

Question 3

Primary iron storage protein of body

Answer 3

Ferritin = cellular storage protein for iron

*Acute phase reactant, elevated in inflammation,

Question 4

What happens to transferrin concentration in iron deficiency?

Answer 4

Increased

Question 5

Iron overdose causes what acid/base disorder?

Answer 5

Anion Gap Metabolic Acidosis

Question 6

What two enzymes require zinc?

Answer 6

Carbonic anhydrase

Lactate dehydrogenase

Question 7

Peripheral neuropathy - wrist drop and foot drop

Burton Lines on gingivae and metaphyses of long bones

Abdominal pain

Sideroblastic anemia
Basophilic stippling on RBCs

Answer 7

Lead poisoning

Question 8

What enzymes does lead inhibit?

Answer 8

Ferrochelatase
ALA- dehydratase

(Decreased heme synthesis and increased RBC protoporphyrin)

Question 9

Treatment for lead poisoning

Answer 9

Succimer
EDTA
Dimercaprol

Question 10

Where does mercury toxicity accumulate?

Answer 10

Kidney and brain

Question 11

What is the physiologic active form of Vit D?

Answer 11

1,25 (OH)2 D3 = calictriol

1 st hydroxylation = liver
2nd hydroxylation = kidney

Question 12

Bones
Stones
Groans
Psychiatric Overtones

Answer 12

Hypercalcemia

Question 13

Why are neonates deficient in Vit. K?

Answer 13

They have a sterile gut, and Vit is synthesized by intestinal flora

Question 14

Why is vit K necessary fro coagulation?

Answer 14

Cofactor for gamma carboxylation of factors 10, 9, 7, 2

“DISCo started in 1972”

*Newborns receive single dose of IM Vit K at birth

Question 15

Bitot spots on conjunctiva

Keratomalacia (conreal degeneration)

Answer 15

Vit. A. deficiency

Question 16

Megaloblastic Anemia
Hypersegmented neutrophils
Increased serum methylmalonic acid levels

Answer 16

Vit. B12 deficiency = cobalamin

Question 17

Antioxidant vitamins?

Answer 17

Vitamin E

Vitamin C = ascorbic acid

Question 18

Main reactions of Vit. C?

Answer 18

• Hydroxylation of prolyl and lysyl residues of collagen
• Required for dopamine to NE reaction
• Antioxidant
• Facilities Fe absorption in gut - deficiency can cause Fe deficient anemia!

Question 19

Sore, spongy gums
Poor wound healing
Bleed mucous membranes
Spots on the skin

Answer 19

Vit. C. deficiency = Scurvy

Question 20

Encephalopathy
Oculomotor dysfunction
Gait Ataxia

Answer 20

Wernicke Encephalopathy

Question 21

Memory loss - retrograde and anterograde
Confabulation
Personality changes
Apathy

Answer 21

Korsakoff Syndrome = consequences of chronic wernkicke encephalopathy

Atrophy of mamillary bodies, and medial thalamus

Question 22

Vit. B1 deficiency (Thiamine)

Answer 22

Wet BeriBeri = high out put cardiac failure (dialated cardiomyopathy), edema

Dry BeriBeri = affecting nerves

Question 23

Treament for Wernkick-Korsakoff?

Answer 23

THIAMINE SUPPLEMENTATION!!! Before glucose!!! Glucose will make it worse without thiamine!

Question 24

Enzymes requiring Vit. B1

Answer 24

THIAMINE! = TPP

• Pyruvate dehydrogenase
• alpha ketoglutarate dehydrogenase
• Transketolase
• Branched-chain ketoacid dehydrogenase

Question 25

B2 = riboflavin

Answer 25

FAD, FMN Cofactors in redox reactions *If it has dehydrogenase in the name, likely requires FAD!

Question 26

What Vit. deficiency causes Cheilosis and corneal vascularization?

Answer 26

Vit. B2 = riboflavin

Question 27

B3

Answer 27

Niacin

Question 28

Dermatitis Dementia Diarrhea Broad collar rash Hyperpigmentation of sun-exposed areas

Answer 28

3 D's of pellegra! Niacin deficiency Can be caused by: - Hartnup disease (decreased tryptophan absorbtion) - Malignant carcinoid syndrome (increased tryptophan metabolism) - Isoniazide (decreased Vit. B6)

Question 29

``` Angular cheilosis Glossitis Convulsions Peripheral neuropathy Sideroblastic Anemia ```

Answer 29

Vit B6 deficiency = Pyridoxine Cofactor for transaminations, synthesis of heme, niacin, histamine, NTs (including GABA... why you get convulsions, loss of inhibition)

Question 30

What enzymes require Biotin? (B7)

Answer 30

Carboxylation reactions

Question 31

What can cause a Vit. B7 deficiency?

Answer 31

B7 = Biotin | AVIDIN (egg whites) prevents absorption of biotin

Question 32

``` Marocytic, megaloblastic anemia Hypersegmented polymorphonuclear cells Glossitis No neuro symptoms Normal methylmalonic acid levels ```

Answer 32

Vit B9 = folate deficiency

Question 33

Macrocytic megaloblastic anemia Hypersegmented PMNs Paresthesia Increased serum methylmalonic acid levels

Answer 33

Vit. B12 deficiency = Cobalamin

Question 34

Vitamin deficiency causing convulsions and irritability?

Answer 34

B6 = pyridoxine Needed in synthesis of heme, niacin, histamine, and NTs (5HT, Epi, NE, DA and GABA) Loss of GABA causes the convulsion (loss of inhibition)

Question 35

Where is B12 absorbed?

Answer 35

Termianl Ileum

Question 36

Pernicious Anemia

Answer 36

Autoimmune attack of intrinsic factor, can't abosorb B12 = megalobalstic anemia

Question 37

Vitamin deficiency associated with peripheral neuropathy, glossitis?

Answer 37

``` B6 = pyridoxine B12 = cobalamin ```

Question 38

Vitamin deficiency associated with neural tube defects?

Answer 38

B9 = Folate

Question 39

Vitamin used by pyruvate dehydrogenase and alpha ketoglutarate dehydrogenase?

Answer 39

B1 = Thiamine

Question 40

Vitamin used to elevate HDL and lower LDL?

Answer 40

B3= Niacin

Question 41

Vitamin deficiency can be caused by isoniazide use?

Answer 41

B6 = pyridoxine *Can also cause Niacin (B3) deficiency because B6 is required to make niacin from tryptophan

Question 42

Vitamins critical for DNA synthesis

Answer 42

``` B9= Folate B12 = Cobalamin ```

Question 43

Most common vitamin deficiency in the US?

Answer 43

Foalte

Question 44

Hypersegmented neutrophils

Answer 44

``` B9 = Folate B12= cobalamin ``` *megaloblastic anemia

Question 45

Dilated cardiomyopathy Edema Polyneuropathy

Answer 45

B1 = Thiamine deficiency = Wet BeriBeri

Question 46

Differential for inflammation of sunexposed regions of the body?

Answer 46

- Pellegra - Xeroderma pigmentosa - Porphria Cutena Tarda

Question 47

Role of NADPH in body

Answer 47

Oxidative burst in phagolysosomes HMP shunt

Question 48

Enzyme and co-factor needed to recycle folic acid?

Answer 48

Homocysteine methyl transferase (cofactor = B12)