Chemical Pathology 9 - Nutrition

Question 1

Which are the fat soluble vitamins? (Recall letter and name)

Answer 1

A - Retinol
D - cholecalciferol
E - tocopherol
K - phytomenodione

Question 2

What are the symptoms of vitamin A deficiency?

Answer 2

Colour blindness

Question 3

What are the symptoms of vitamin D deficiency?

Answer 3

Osteomalacia/ ricketts

Question 4

What are the symptoms of vitamin E deficiency?

Answer 4

Anaemia/ neuropathy (rare)

?malignnacy/IHD

Question 5

What are the symptoms of vitamin K deficiency?

Answer 5

Clotting defects

Question 6

How can you test vitamin A levels?

Answer 6

Serum vitamin levels (although pretty much never done)

Question 7

How can you test vitamin D levels?

Answer 7

Serum vitamin levels

Question 8

How can you test vitamin E levels?

Answer 8

Serum vitamin levels

Question 9

How can you test vitamin K level?

Answer 9

Prothrombin time

Question 10

Name vitamins B1, 2, 6 and 12

Answer 10

B1 = thiamin
B2 = riboflavin
B6 = pyridoxine
B12 - cobalamin

Question 11

Which vitamin deficiency causes Beri Beri neuropathy?

Answer 11

B1 (thiamin)

Question 12

What are the symptoms of Beri-Beri?

Answer 12

Wet - CVD → oedema and other heart failure features

Dry - neurological disease, Wernicke’s encephalopathy (Pabrinex to alcoholics)

Question 13

How can vit B1 levels be tested?

Answer 13

Red Blood Cell transketolase (but this takes forever to come back from the lab so is rarely done)

Question 14

What are the symptoms of vit B2 deficiency?

Answer 14

Glossitis

Question 15

What are the symptoms of vit B6 deficiency?

Answer 15

Dermatitis/ anaemia

Question 16

What are the symptoms of vit B12 deficiency?

Answer 16

Pernicious anaemia

Question 17

What test can be used to prove a diagnosis of Wernicke’s encephalopathy?

Answer 17

Red blood cell transketolase

Question 18

What are the symptoms of folate deficiency?

Answer 18

megaloblastic anaemia

NTD

Question 19

What are the symptoms of vit C deficiency?

Answer 19

Scurvy

Question 20

What condition is produced by niacin deficiency?

Answer 20

Pellagra (Dermatitis, diarrhoea, dementia)

Question 21

What states are produced by iron deficiency vs excess?

Answer 21

Deficiency = hypochromic anaemia 
Excess = haemachromatosis

Question 22

What symptoms does zinc deficiency produce?

Answer 22

Dermatitis

Question 23

What does iodine deficiency lead to?

Answer 23

goitre, hypothyroidism

Question 24

How can Wilson’s disease be tested for?

Answer 24

Caeruloplasmin level

Caeruloplasmin = copper-binding protein (LOW in Wilson’s disease)

excess copper

Question 25

What is a complication of Wilson's disease?

Answer 25

infertility

Question 26

Recall the hormones involved in energy expenditure

Answer 26

Question 27

Which hormones are produced by the adipose tissue?

Answer 27

adiponectin leptin (anti-hunger)

Question 28

Deficiency in which hormone can cause insulin resistance?

Answer 28

Adiponectin ↓ IN OBESITY → insulin resistance (i.e. in obese people)

Question 29

Where is adiponectin produced?

Answer 29

White adipose tissue

Question 30

What is carbohydrate deficient transferrin measurement used for?

Answer 30

To detect alcohol abuse

Question 31

What does fluoride deficiency cause?

Answer 31

dental caries

Question 32

What is the role of insulin?

Answer 32

release after eating causes → satiety + ↑ energy expenditure (thermogenesis)

Question 33

What is the role of ghrelin?

Answer 33

hunger-hormone - high before eating

Question 34

What is the role of PYY?

Answer 34

satiety hormone produced in the intestines increase after eating a meal

Question 35

How do you calculate BMI?

Answer 35

Weight/height^2

Question 36

How can you assess protein in the body?

Answer 36

Nitrogen excretion and balance Tracer techniques

Question 37

What can protein deficiency lead to?

Answer 37

**Marasmus (right image)** * lack of intake of CHO, lipids and protein * Shrivelled * Growth retarded * Severe muscle wasting * No SC-fat **Kwashiorkor (left image)** * protein deficiency * Oedematous * Scaling/ulcerated * Lethargic * Large liver, SC-fat * Protein deficient

Question 38

Which types of fatty acids are good and bad?

Answer 38

Polyunsaturated fatty acids (PUFA) - good FAs, essential Trans-fatty acids - bad

Question 39

LDL vs HDL

Answer 39

**LDL** high saturated fat → high LDLs high intake of PUFA → lower cholesterol (mainly LDL) **HDL** ↑HDL ↓ ischaemic heart disease risk Women have higher HDL levels Alcohol can cause an increase in HDLs Obesity lowers HDLs

Question 41

What types of fat are affected by fasting?

Answer 41

HDL/LDL unaffected by fasting triglycerides (glycerol and FAs) do change with fasting

Question 42

What are the 5 features of metabolic syndrome?

Answer 42

Question 43

What are some medical treatments for metabolic syndrome?

Answer 43

Orlistat (pancreatic lipase inhibitor) GLP-1 (causes a feeling of satiety)

Question 44

What are some surgical options for metabolic syndrome?

Answer 44

Bariatric Surgery – a form of METABOLIC surgery * Adjustable band * Roux-en-Y gastric bypass * Duodenal jejunal sleeve