Nutrition

Question 1

What is vitamin B6

Answer 1

Vitamin B6 is a water soluble vitamin of the B complex group.

It is converted to pyridoxal phosphate (PLP) which is a cofactor for many reactions including transamination, deamination and decarboxylation.

Question 2

Causes of vitamin B6 deficiency

Answer 2

isoniazid therapy

Question 3

Consequences of vitamin B6 deficiency

Answer 3

peripheral neuropathy

sideroblastic anemia

Question 4

vitamin B6 is also known as

Answer 4

pyridoxine

Question 5

Vitamin C is also known as

Answer 5

ascorbic acid

Question 6

Vitamin C Functions

Answer 6

antioxidant
collagen synthesis
facilitates iron absorption
cofactor for norepinephrine synthesis

Question 7

Vitamin C deficiency (scurvy) leads to

Answer 7

defective synthesis of collagen resulting in capillary fragility (bleeding tendency) and poor wound healing

Question 8

Features vitamin C deficiency

Answer 8

gingivitis, loose teeth
poor wound healing
bleeding from gums, haematuria, epistaxis
general malaise

Question 9

Vitamin A is water solubke

Answer 9

false

fat soluble

Question 10

Vitamin A/retinol Functions

Answer 10

converted into retinal, an important visual pigment
important in epithelial cell differentiation
antioxidant

Question 11

Consequences of vitamin A deficiency

Answer 11

night blindness

Question 12

Name all the Vitamin B types

Answer 12

B3 Niacin
B6 Pyroxidine
B7 Biotin
B9 Folic Acid
B12 Cyanocobalamin

Question 13

Deficiency of Thiamine leads to?

Answer 13

Beriberi
polyneuropathy, Wernicke-Korsakoff syndrome
heart failure

Question 14

Deficiency of Niacin leads to?

Answer 14

Pellagra
dermatitis
diarrhoea
dementia

Question 15

Deficiency of Pyridoxine leads to?

Answer 15

Anaemia, irritability, seizures

Question 16

Deficiency of Biotin leads to?

Answer 16

Dermatitis, seborrhoea

Question 17

Deficiency of Vitamin D leads to?

Answer 17

Rickets, osteomalacia

Question 18

Deficiency of Vitamin E leads to?

Answer 18

Mild haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy

Question 19

Deficiency of Vitamin K leads to?

Answer 19

Haemorrhagic disease of the newborn, bleeding diathesis

Question 20

NICE define malnutrition as the following:

Answer 20

a Body Mass Index (BMI) of less than 18.5; or
unintentional weight loss greater than 10% within the last 3-6 months; or
a BMI of less than 20 and unintentional weight loss greater than 5% within the last 3-6 months

Question 21

MUST (Malnutrition Universal Screen Tool) takes into account?

Answer 21

BMI, recent weight change and the presence of acute disease

Question 22

Management of malnutrition is difficult. NICE recommend the following points:

Answer 22

dietician support if the patient is high-risk
a ‘food-first’ approach with clear instructions (e.g. ‘add full-fat cream to mashed potato’), rather than just prescribing oral nutritional supplements (ONS) such as Ensure
if ONS are used they should be taken between meals, rather than instead of meals

Question 23

Niacin is a water soluble vitamin of the B complex group. It is a precursor to

Answer 23

NAD+ and NADP+ and hence plays an essential metabolic role in cells.

Question 24

Hartnup’s disease:

Answer 24

hereditary disorder which reduces absorption of tryptophan

Question 25

carcinoid syndrome:

Answer 25

ncreased tryptophan metabolism to serotonin

Question 26

Thiamine is therefore important in

Answer 26

catabolism of sugars and aminoacids

Question 27

clinical consequences of thiamine deficiency are therefore seen first in which type of tissues

Answer 27

clinical consequences of thiamine deficiency are therefore seen first in highly aerobic tissues such as the brain (Wenicke-Korsakoff syndrome) and the heart (wet beriberi).

Question 28

Causes of thiamine deficiency:

Answer 28

alcohol excess. Thiamine supplements are the only routinely recommend supplement in patients with alcoholism malnutrition

Question 29

Wernicke's encephalopathy features?

Answer 29

nystagmus, ophthalmoplegia and ataxia

Question 30

Korsakoff's syndrome features?

Answer 30

amnesia, confabulation

Question 31

dry beriberi is what secondary to thiamine defiency?

Answer 31

peripheral neuropathy

Question 32

wet beriberi is what secondary to thiamine defiency?

Answer 32

dilated cardiomyopathy

Question 33

Symptoms and signs include of scurvy

Answer 33

Follicular hyperkeratosis and perifollicular haemorrhage Ecchymosis, easy bruising Poor wound healing Gingivitis with bleeding and receding gums Sjogren's syndrome Arthralgia Oedema Impaired wound healing Generalised symptoms such as weakness, malaise, anorexia and depression

Question 34

Total iron binding capacity (TIBC) raised in?

Answer 34

raised in iron deficiency anaemia (IDA) | raised in pregnancy and by oestrogen

Question 35

Ferritin raised/ low in?

Answer 35

raised in inflammatory disorders | low in IDA

Question 36

Anaemia of chronic disease bloods?

Answer 36

normochromic/hypochromic, normocytic anaemia reduced serum and TIBC normal or raised ferritin

Question 37

Ferritin is an acute phase protein

Answer 37

true may be synthesised in increased quantities in situations where inflammatory activity is ongoing. Falsely elevated results may therefore be encountered clinically and need to be taken in the context of the clinical picture and blood results.

Question 38

We can split the causes of increased ferritin levels into 2 distinct categories based on?

Answer 38

Without iron overload (around 90% of patients) With iron overload (around 10% of patients)

Question 39

increased ferritin levels Without iron overload (around 90% of patients) causes?

Answer 39

``` Inflammation (due to ferritin being an acute phase reactant) Alcohol excess Liver disease Chronic kidney disease Malignancy ```

Question 40

increased ferritin levels With iron overload (around 90% of patients) causes?

Answer 40

Primary iron overload (hereditary haemochromatosis) Secondary iron overload (e.g. following repeated transfusions)

Question 41

The best test to see whether iron overload is present is transferrin saturation.

Answer 41

true

Question 42

Ferritin levels may be decreased in

Answer 42

Because iron and ferritin are bound the total body ferritin levels may be decreased in cases of iron deficiency anaemia.