Chemical Pathology - Nutrition

Question 1

deficiency and excess of Vit A (retinol)

Answer 1

Def: colour blindess
Excess: exfoliation, hepatitis
test for it in the serum

Question 2

deficiency and excess of Vit D (cholecalciferol)

Answer 2

Def: osteomalacia, rickets
Excess: hypercalcaemia
test for it in the serum

Question 3

deficiency of Vit E (tocopherol)

Answer 3

anaemia, neuropathy, IHD

test for it in the serum

Question 4

deficiency of Vit K (phyto-menadione)

Answer 4

defective clotting

test the PTT

Question 5

deficiency of B1 (thiamin) and how to test for it

Answer 5

Def: Beri-Beri, Neuropathy, Wernicke syndrome
Test: RBC transketolase

Question 6

deficiency of B2 (riboflavin) and how to test for it

Answer 6

Def: glossitis
Test: RBC glutathione reductase

Question 7

deficiency and excessof B6 (rpyridoxine) and how to test for it

Answer 7

Def: dermatitis, anaemia
Excess: neuropathy
Test: RBC AST activation

Question 8

deficiency of B12 (cobalamin) and how to test for it

Answer 8

Def: pernicious anaemia
Test: serum B12

Question 9

deficiency and excess of Vit C and how to test for it

Answer 9

Def: scurvy
Excess: renal stones
Test: plasma

Question 10

deficiency of Folate and how to test for it

Answer 10

Def: megaloblastic anaemia, neural tube defect
Test: RBC folate

Question 11

deficiency of Niacin (B3)

Answer 11

pellagra

Question 12

what are the fat soluble vitamins? where are they stored?

Answer 12

A,D,E,K

stored in adipose tissue

Question 13

what are the types of Beri Beri?

Answer 13

B1/thiamine def

1. Wet: characterised by CVD (oedema, HF)
2. Dry: characterised by neurological disease

Question 14

what is pellagra (niacin/B3 def) characterised by?

Answer 14

diarrhoea
dermatitis
dementia
death (if untreated)

Question 15

deficiency and excess of iron? how to test?

Answer 15

Def: hypochromic anaemia
Excess: haemochromatosis
Test: FBC, Fe, Ferritin

Question 16

deficiency of iodine? test?

Answer 16

Def: goitre, hypothyroid
Test: TFT

Question 17

deficiency of zinc?

Answer 17

Def: dermatitis

Question 18

deficiency and excess of iron? how to test?

Answer 18

Def: anaemia
Excess: Wilson’s
Test: Cu, caeroplasmin (copper-binding protein, is low in Wilson’s)

Question 19

what does an ideal diet consist of?

Answer 19

50% carbs
33% fats
17% proteins

Question 20

what hormones does white adipose tissue produce?

Answer 20

• adiponectin (dec in obese people = leads to insulin resistance)
• leptin (anti-hunger hormone)

Question 21

what does insulin release after a meal result in?

Answer 21

• feeling of satiety

- increase in energy expenditure (thermogenesis)

Question 22

what does ghrelin do?

Answer 22

hunger hormone

high before eating

Question 23

what does PYY do?

Answer 23

satiety hormone
produced in intestines
PYY increase after eating a meal

Question 24

what values of BMI represent obesity/ overweight?

Answer 24

25-30: overweight
>30: obese
>40: morbid obese

Question 25

what definition of obesity is linked to CHD risk?

Answer 25

waist circumference

Question 26

what are the different categories of amino acids?

Answer 26

- indispensable (cannot be made, needed from diet) e.g. leucine - conditionally indispensable (needed at certain parts of life e.g. cysteine in pregnancy) - dispensable (body can produce e.g. alanine)

Question 27

how do you assess protein intake?

Answer 27

nitrogen excretion and balance | tracer techniques

Question 28

what does pancreatic lipase do?

Answer 28

breaks down fatty acids by hydroxylation

Question 29

what 5 features does the metabolic syndrome consist of?

Answer 29

1. fasting glucose (>6.0mmol/l) 2. HDL 3. waist circumference 4. HTN 5. microalbumin, insulin resistance

Question 30

obesity treatment

Answer 30

- exclude endocrine cauaes - educate - diet and exercise - medical therapy (orlistat and GLP-1) - surgical therapy

Question 31

MOA of orlistat and GLP-1

Answer 31

``` orlistat = pancreatic lipase inhibitor GLP-1 = causes a feeling of satiety ```

Question 32

3 forms of bariatric surgery

Answer 32

- adjustable band: silicone ring around top of stomach - Roux-en-Y Gatric bypass: stomach made smaller, first part of duodenum and most of stomach is bypassed - duodenal-jejunal sleeve: sleeve from pyloric sphincter to jejunum

Question 33

what is marasmus and how does it present?

Answer 33

lack of intake of CHO, lipids and protein | Px: shrivelled, severe muscle wasting, growth retarded, no SC fat

Question 34

what is kwashiorkor and how does it present?

Answer 34

protein def | Px: oedematous, lethargic, protein def, scaling/ulcerated, large liver, SC fat