Week 1: Nutrition Flashcards
1
Q
Carbohydrates and proteins both provide about _____ of energy per gram
A
4 kcal
2
Q
Fats provide about _____ of energy per gram
A
9 kcal
3
Q
Alcohol provides about _____ of energy per gram
A
7 kcal
4
Q
Humans can synthesize what amino acids?
A
Non-essential amino acids
5
Q
Humans need dietary sources to get these amino acids
A
Essential amino acids
6
Q
_____ appear to have anti-inflammatory effects, promote healthy brain development, and may help prevent cardiovascular disease
A
omega-3 fatty acids
7
Q
A
8
Q
Obesity results when energy intake chronically _____ energy expenditure
A
exceeds
9
Q
_____ is considered a form of malnutrition because it is ultimately caused by excess of one or more macronutrients, and it significantly increases one’s risk for many chronic diseases.
A
Obesity
10
Q
severe undernourishment causing weight to be < 60% of expected value
A
Marasmus
11
Q
severe protein malnutrition resulting in fluid retention and distended abdomen
A
Kwashiorkor
12
Q
a muscle wasting disorder seen in several chronic diseases, including some forms of cancer, pulmonary and renal diseases
A
Cachexia
13
Q
A
A - Kwashiorkor
B - Marasmus
C - Cachexia
14
Q
What are the fat soluble vitamins?
A
ADEK
15
Q
What are the water soluble vitamins?
A
BC
16
Q
Vitamin B1 name
A
Thiamine
17
Q
Vitamin B2 name
A
Riboflavin
18
Q
Vitamin B3 name
A
Niacin, Nicotinic acid
19
Q
Vitamin B5 name
A
Pantothenic acid
20
Q
What is the function of Vitamin B1?
A
21
Q
What does a deficiency in Vitamin B1 cause?
A
22
Q
What is a deficiency in Vitamin B1 that is alcohol induced?
A
23
Q
What is the function of Vitamin B2?
A
24
Q
What does a deficiency in Vitamin B2 cause?
A
25
What is the function of Vitamin B3?
26
What does a deficiency in vitamin B3 cause?
27
What does an excess of Vitamin B3 cause?
28
What is the function of vitamin B5?
29
Vitamin B6 name
Pyridoxine, Pyridoxamine, and Pyridoxal
30
Vitamin B7 name
Biotin
31
Vitamin B9 name
Folic acid
32
Vitamin B12 name
Cobalamin
33
Vitamin C name
Ascorbic acid
34
What is the function of vitamin B6?
35
What does a deficiency in vitamin B6 cause?
36
W/hat does an excess of Vitamin B6 cause?
37
What is the function of Vitamin B7?
38
What is the function of Vitamin B9?
39
What does a deficiency of Vitamin B9 cause?
40
What is the function of Vitamin C?
41
What does a deficiency in vitamin C cause?
42
43
44
## Footnote
Isoniazid is used to treat TB (R**I**PE) and it inactivates pyridoxine
45
46
## Footnote
Dermatitis in sun-exposed regions (Pellagra)
47
Vitamin A name
Retinol, Retinal, Retinoic acid
48
What is a precursor of vitamin A?
B-carotene
49
Vitamin D name
Cholecalciferol (D3)
Calcitriol - active form
Ergocalciferol (D2) - if obtained from plant or fungus
50
Vitamin E name
Alpha-Tocopherol
51
Vitamin K name
menadione, menaquinone, and phylloquinone
## Footnote
Very rarely referred to as this, just be able to recognize these as Vitamin K
52
What is the function of Vitamin A?
53
What does a deficiecy in Vitamin A cause?
54
What does an excess in Vitamin A cause?
55
What is the function of Vitamin D?
56
What does a defiency in Vitamin D cause?
57
What does an excess of Vitamin D cause?
58
What is the function of Vitamin E?
59
What does a deficiency of Vitamin E cause?
60
What does an excess of Vitamin E cause?
61
What is the function of Vitamin K?
62
What does a deficiency in Vitamin K cause?
63
What does an excess of Vitamin K cause?
64
65
66
Calcium (Ca)
67
Chloride (Cl)
68
Magneisum (Mg)
69
Phosphorus (P)
70
Potassium (K)
71
Sodium (Na)
72
73
Only functions as an enzyme cofactor
Copper (Cu) and Manganese (Mn)
74
Flouride (F-)
75
Iron (Fe)
76
Zinc (Zn)
77
_____ deficiency is the most common nutritional deficiency, affecting about 1/3 of the world's population
Iron (Fe)
78
Zinc (Zn)
79
Genetic Copper deficiency due to a mutation in copper transporter required for absorptiion and distribution
Menkes disease
80
What is the function of Iodine?
81
What is the function of Molybdenum (Mo)
Enzyme cofactor
82
What is the function of Selenium (Se)
Requird for the rare amino acid selenocysteine
83
What does a deficiency of dietary iodine cause?
goiter or if severe hypothyroidism
84
85
86
## Footnote
itamin D is hydroxylated first in the liver (25-OH D) and then in the kidney (1,25(OH)2D) to convert it to its active form. Many patients with chronic kidney disease are unable to fully activate vitamin D. This decreases calcium absorption from the gut and stimulates the parathyroid gland to secrete more PTH.
87
Zinc
## Footnote
acrodermatitis, a condition caused by zinc deficiency
88
89
A 4-week-old male infant was brought to the emergency department (ED) by his parents because of lethargy, irritability, decreased interest in breastfeeding, and one episode of emesis 3 hours before arriving at the ED. Parents refused newborn screening, vaccinations and prophylactic treatments. Upon physical examination the infant was irritable and crying and was unable to be consoled by his mother. He weighed 5.2 kg (75th percentile) and had a head circumference of 38.0 cm (50th percentile) and a length of 55 cm (50th percentile). His vital signs were as follows: temperature, 38.1°C; heart rate, 112 beats per minute; respiratory rate, 49 breaths per minute; blood pressure, 100/38 mm Hg; and oxygen saturation, 99% on room air. His head was atraumatic and normocephalic, with anterior and posterior fontanels open and notably full. Other PE findings were normal. A computed tomography (CT) scan of the head was obtained, which revealed a large left frontal hemorrhage, large subdural and subarachnoid areas of bleeding, and an 11-cm midline shift with probable left uncal herniation and bilateral occipital infarcts. In light of the CT findings, additional laboratory tests were performed and revealed a prothrombin time (PT) greater than 140 seconds (normal, 11.0–12.5 seconds) and a partial thromboplastin time (PTT) of 117 seconds (normal, 60–70 seconds). This infant most has a deficiency of which of the following nutrients?
Vitamin K
## Footnote
Vitamin K is required for normal blood clotting. We get most of our vitamin K from leafy green vegetables and intestinal microbiota. To protect infants from vitamin K deficiency, and inappropriate bleeding, they are usually given a vitamin K injection within 6 hours of birth. This infant did not receive a vitamin K injection.
90
A 20-year-old female patient was admitted to the hospital for persistent confusion, ataxia, vomiting, diarrhea, and nausea. She had Crohns disease since age 9 and has been on chronic total parenteral nutrition (TPN). Two months before admission, multivitamin infusion (MVI) was discontinued in the TPN because of the shortage of its supply. An oral multivitamin tablet was substituted instead. Fat stores and muscle tissue were decreased. Her respiratory rate was 24/min. Her blood pressure, while she was standing, was 105/65 mmHg. Liver tests were normal. The serum lactate concentration was substantially increased. Magnetic resonance imaging (MRI) showed several areas of abnormally high signal on T2- weighted images (transverse magnetization, which generates a cross-section image via radio-frequency pulse) in the brainstem, thalamus, and mamillary bodies. A deficiency of what nutrient is most likely in this patient?
Vitamin B1 (Beri Beri)
91
A 23-year-old woman presents to the sports clinic because of a perceived drop in her endurance. She runs about 70 miles per week, and is training for a triathlon. Her body fat is 12% and her BMI is stable at 18. Her last menstrual period was at age 20. She appears pale and her fingernails are thin and convex. Labs show: Hemoglobin 9 g/dL (normal: 12-16 g/dL), Hematocrit 26% (normal: 35-44%), MCV 58 fl (normal: 77-94 fl), MCHC 28% (normal: 32-36%), Fe 15 µg/dL (normal: 60-170 µg/dL), total iron binding capacity (TIBC) increased, Ferritin 12 µg/dL (normal: 10-150 µg/dL), Reticulocyte count <1% (normal: 1-2%). The best treatment for her is:
Give standard dose of oral iron therapy for 6-12 months.
92
A 5-year-old boy who recently arrived in the US as a refugee from Somalia was seen for a well-child visit. His parents described through an interpreter how he has always been small and how he struggled to overcome a bout of measles. He has an overall malnourished appearance. Ophthalmologic examination showed small foamy white spots on the outer aspects of the conjunctiva. In addition to general malnutrition, a lack of which specific nutrient has most likely compromised his ability to fight infections and caused the finding on eye examination?
Vitamin A
## Footnote
It has essential roles in cellular growth and differentiation, the immune response and epithelial integrity.
93
A 73-year-old woman comes to the physician because of a 2-month history of diffuse weakness and tingling of her arms and legs. Neurologic examination shows weakness of the extensor and flexor muscles of the lower extremities. Knee and ankle deep tendon reflexes are exaggerated. Sensation to vibration and position is decreased in all extremities, but the decrease is more prominent in the lower extremities than in the upper extremities. This patient most likely has a deficiency of which of the following vitamins?
Vitamin B12
## Footnote
Vitamin B12 deficiency results in both megaloblastic anemia and in neurologic pathology (including paresthesias, numbness, weakness, loss of dexterity, impaired memory, and personality changes).
94
A 48-year-old woman with a pre-operative BMI of 53.3 kg/m2 underwent bariatric surgery (Roux-en-Y bypass) for weight loss. Due to insufficient weight loss, she underwent two more surgeries that successively shortened the length of intestine available for nutrient absorption. Following the third surgery, she began to lose weight; 2 years later her BMI was 28.7 kg/m2. At this time, she complained of increased vomiting, steatorrhea, diarrhea, weakness and lack of energy. She described the gradual development of leg edema, dry skin, loss of hearing, dry and itchy eyes and visual disturbances, especially at night. However, she was particularly low in one vitamin and this deficiency is likely to be largely responsible for many of her symptoms. Which vitamin is this?
Vitamin A
95
A 32-year-old pregnant woman, gravida 3, para 2, presents to the ER at 23 weeks gestation with chief complaints of vaginal spotting and mild abdominal pain. She slipped on the ice 3 hours ago, and noted the bleeding after going to the bathroom. An hour later she had some abdominal pain, and her OB/GYN’s office recommended that she come in for evaluation. Patient states that she is much more tired with this pregnancy, but attributes this to having 2 small children at home. She also describes being short of breath, which she experienced with the other pregnancies, but noted that it occurred earlier with this pregnancy. She appears her stated age, pregnant, pale and in no acute distress. Her vital signs are: temp: 98.6, pulse: 88, Resp. rate: 19, BP: 118/72, height:5’5’’, weight: 142 lbs, pre-pregnancy weight: 135 lbs. Physical exam is normal for a pregnant woman, with skin paleness noted. A quick survey of her common dietary habits indicates that she eats mostly pre-prepared foods and has not specific food aversions. She states that she ran out of her prenatal vitamins a few months ago and hasn’t been taking any since. She is most likely to be deficient in what micro- or macronutrient?
Iron
96
A 16-year-old girl was hospitalized due to the onset of polymorphic, transient mainly cerebral symptoms. Her first symptoms included left spastic hemiplegia with bilateral Babinski's reflex and diffuse brain edema. Her hands and face had a red, glossy appearance, with some patches of rough, peeling skin. Signs of the upper motor neuron lesions and myoclonic jerks of limbs and face were persistent. Her mental state at the time of hospitalization was changed and characterized by bradypsychic, torpid, disoriented in time and confused. She also developed psychotic episodes. Last summer, her younger brother developed a similar rash on his face and arms. These siblings are most likely to have inherited pathologic variants in what type of intestinal transporter, resulting in which micronutrient deficiency?
Vitamin B3
## Footnote
This patient has Hartnup’s disease, caused by mutation in the transporter for nonpolar (hydrophobic) amino acids including tryptophan. She is showing symptoms of pellagra (dementia and dermatitis) because niacin (vitamin B3) comes both directly from the diet and from tryptophan metabolism (it has been estimated that ~half of the nicotinamide in most people comes from tryptophan).
97
A 70-year-old female in her usual state of health was instructed to begin taking a vitamin supplement. Three months later she developed confusion, slurred speech, unstable gait, and increased fatigue. Her symptoms were most likely caused by a pharmaceutical error in dispensing which micronutrient?
Vitamin D
## Footnote
She was accidentally given a toxic dose of vitamin D (50,000 IU per day instead of 1000 IU). She developed acute kidney injury due to the hypercalcemia. Both resolved 5 months after she stopped taking the supplement.
98
A 40-year-old woman, with past medical history significant for depression, presented with a chief complain of diffuse bone pain and proximal muscular weakness, mainly in the lower extremities and to a less extent in both shoulders for six months. The pain and weakness progressed to the point that she had difficulties in rising from a chair, holding her arms up and walking, and inability to ascend stairs. Clinical examination showed evidence of bilateral, proximal muscle atrophy and weakness in the upper and lower extremities, and hypoactive reflexes in four extremities. Her hip range of motion was limited and painful. She had a waddling gait pattern. A deficiency of which of the following is the most likely cause?
Vitamin D deficiency
## Footnote
She is showing classic signs of osteomalacia – proximal muscle weakness and bone pain.
99
A 65-year-old female reports about 2 months of tiredness, feeling faint from “getting up too fast”, and “memory problems” during a hypertension checkup. On review of symptoms, she reports difficulty concentrating, fatigue, feeling faint when she stands quickly, and vague gastrointestinal discomfort with some decrease in appetite. She denies any history of previous trauma, diplopia, dysphagia, vertigo, vision loss, loss of consciousness, back pain, or symptoms of bowel or bladder dysfunction. Her family history is negative for neurologic, psychiatric, and autoimmune diseases. Her medications include an antihypertensive as well as an occasional anti-inflammatory drug for episodic headache. Social history reveals a single woman who smokes about one-half pack of cigarettes per day, drinks alcohol only socially, and denies illicit drug use. She has a high school education and, until recently, has worked in the office of a trucking company. The general physical exam is unremarkable except for orthostatic hypotension and weight loss of 3 pounds since her last visit 6 months ago. She is alert and oriented times three. Her Mini-Mental Status Exam score is 26 out of 30. She misses one point on serial 7s and is able to recall three of three items. There is evidence of bilateral mildly diminished vibration and proprioception. Her reflexes are 3+/4+ throughout with negative Babinski reflex. Lab studies showed a hematocrit of 32%, hemoglobin of 10.3 and MCV of 112 fL. Serum vitamin B12 is 215 pg/mL (ref = 210-911), methylmalonic acid is 0.6 µmol/L (0.00-0.40 µmol/L) and homocysteine is 17 µmol/L (< 11 µmol/L). This patient most likely has a functional deficiency in what nutrient?
Vitamin B12
## Footnote
acrocytic anemia, with diminished vibration and proprioception are indicative of a vitamin B12 deficiency. While the serum B12 lab results came back within the normal range, the elevated methylmalonic acid and homocysteine (substrates for the 2 B12-requiring human enzymes) indicates a functional deficiency in vitamin B12.
100
An 8-week-old boy presents with failure to thrive from birth; he did not have any newborn screening. Based on extent of breast feeding and formula supplementation described by parents he should be recieving adequate nutrients. On examination he was noted to be wasted, pale, and lethargic. His chest was a little over inflated and there was an audible expiratory wheeze. The heart sounds were normal and the abdomen was soft without masses or organomegaly. Lab results show anemia with elevated reticulocytes and unconjugated bilirubin. Coomb's test was negative, and glucose-6-phosphate dehydrogenase, pyruvate kinase, urinary adrenaline, and metadrenaline metabolites were with in normal limits. A CF newborn screening test and sweat test come back positive. A skeletal survey failed to show evidence of pathological bone lesions and an abdominal ultra-sound scan was normal. This infant is showing signs of which micronutrient deficiency?
Vitamin E
## Footnote
This infant with cystic fibrosis has a hemolytic anemia most likely caused by deficiency of the fat-soluble vitamin E. Malabsorption is the most common cause of vitamin E deficiency, as this vitamin is found fairly ubiquitously in foods containing fats and oils (including wheat, nuts, seeds and vegetable oils). Untreated cystic fibrosis results in nutrient malabsorption because thick mucus plugs the pacreatic duct and pancreatic enzymes cannot make it to the small intestine.
101
An 8-year-old boy with autism spectrum disorder presented with swollen, bleeding gums. Physical exam revealed gum hypertrophy and petechiae, particularly notable on his shins (see image below).
A dietary history revealed that for the past 3 years the child had eaten a diet consisting of white foods: chicken nuggets, crackers, cookies, milk and water. He refused all other foods and did not take any supplements. This child is most likely deficient in which of the following?
Vitamin C
## Footnote
His bleeding gums and petechiae are consistent with scurvy.
102
A 38-year-old man who recently immigrated to the USA comes to the physician because of a 1-month history of cough and a 4.5-kg (10-lb) weight loss. Physical examination shows no abnormalities. A chest x-ray shows a right upper lobe infiltrate. One of three sputum samples is positive for acid-fast bacilli. Treatment with isoniazid, rifampin, ethambutol, and pyrazinamide is started. Which of the following should be added to the medication regimen to prevent neurologic toxicity in this patient?
Vitamin B6 (Pyridoxine)
103
A 15-year-old girl who is a ballet dancer has not had a menstrual period for the past 3 months. Menses were previously regular at 29-day intervals. She has lost weight over the past year; her weight is 70% of that expected for her height. She is afebrile and has purpuric lesions on her extremities and trunk. Platelet, absolute neutrophil, and lymphocyte counts are below the reference range. She has macrocytic anemia. The most likely cause of these symptoms is a deficiency of which of the following nutrients?
Folic acid
## Footnote
Folic acid is required for production of both white and red blood cells. Macrocytic anemia is most commonly caused by folate or vitamin B12 deficiency. She is also most likely calorically deprived, but the specific signs and symptoms given are reflective of folate deficiency. This question comes from the USMLE Step 1 sample questions.
