Vitamins

Question 1

Vitamin A Use

Answer 1

Tx measles and AML: subtype APL (all trans retinoic acid)

Acne and wrinkles

Question 2

Vitamin A deficiency

Answer 2

Night blindness
Dry scaly skin (xerosis cutis)
Corneal degeneration (keratomalacia)
Bitot spots (on conjunctiva)

Question 3

Vitamin A excess

Answer 3

Acute: vertigo, blurred vision
Chronic: alopecia, hepatic toxicity, arthralgias, pseudo tumor cerebrum

Question 4

Severe Vit A side effects

Answer 4

Teratogenic: negative pregnancy test and two forms of contraception before using isotretinoin

Question 5

Fat soluble

Answer 5

Dissolves in fat: taken up by chylomicrons

More likely to be stored, greater chance of toxicity

Question 6

Vitamin B1 Function

Answer 6

Thiamine
TPP used for: pyruvate dehydrogenase, alpha ketoglutarate dehydrogenase, transketolase
“ATP”

Question 7

Vitamin B1 deficiency

Answer 7

Impaired glucose breakdown: (brain, heart affected first)

Wernicke-Korsakoff syndrome and beriberi (malnutrition and alcoholism)

Question 8

Vitamin A Goljan

Answer 8

Big game hunter who has headaches

Question 9

Wernicke-Korsakoff syndrome

Answer 9

Confusion, ophthalmoplegia, ataxia + confabulation

Damage to medial dorsal nucleus of thalamus and mammory bodies

Question 10

Dry vs. wet beriberi

Answer 10

Dry: muscle wasting, foot drop
Wet: high output cardiac failure (biventricular dilation)

Question 11

Diagnosis of B1 deficiency

Answer 11

Increased RBC transketolase activity following B1 administration

Question 12

Vit B1 Goljan

Answer 12

Give IV thiamine before giving IV glucose in ER

Question 13

Vitamin B2 function

Answer 13

Riboflavin: FMN

Redox reactions

Question 14

Vit B2 deficiency

Answer 14

Cheilosis, corneal vascularization

Question 15

Vitamin B3 function

Answer 15

Niacin

NAD/NADP

Question 16

Vit B3 synthesis

Answer 16

Derived from TRYPTOPHAN

Need B2 and B6 (riboflavin and PLP)

Question 17

Vit B3 use

Answer 17

Dyslipidemia: lower levels of VLDL and raises HDL

Take Asa with niacin to prevent facial flushing: due to prostaglandins, not histamine

Question 18

Hartnup Disease

Answer 18

Autosomal recessive
Deficiency of neutral amino acid transporters in proximal renal tubular cells and on enterocytes
Decreased tryptophan–>pellagra like s/s.
Tx: high protein diet and nicotinic acid

Question 19

Vit B3 deficiency

Answer 19

Glossitis
Pellagra: dermatitis (Broad collar rash), dementia and diarrhea
–hyperpigmentation of sun exposed limbs

Question 20

Vit B5

Answer 20

Pantothenic acid
Component of Coenzyme A
Fatty acid synthase

Question 21

Vitamin B6 function

Answer 21

Pyridoxine

Necessary for heme synthesis, transamination reactions and neurotransmitters (serotonin, epi, NorE, dopa, GABA)

Question 22

Vit B6 deficiency

Answer 22

Convulsions, hyper-irritability, peripheral neuropathy
Inducible by ISONIAZID
Causes SIDEROBLASTIC ANEMIA

Question 23

Vit B7

Answer 23

Biotin

Carboxylation enzymes

Question 24

Vit B7 deficiency

Answer 24

Rare
Antibiotic use or raw egg white ingestion
Go Bald, dermatitis, enteritis

Question 25

Vitamin B9

Answer 25

Folate Converted to THF and used for 1 carbon methylation reactions Synthesis of nitrogenous bases in DNA and RNA Found in leafy green veggies Absorbed in jejunum Stored in liver

Question 26

Vit B9 deficiency

Answer 26

Macrocytic, megaloblastic anemia Hypersegmented neutrophils Glossitis No neuro s/s and NO elevation of methylmalonic acid Increased homocysteine MOST COMMON VIT DEFICIENCY IN THE US May be drug induced: phenytoin, sulfonamides, methotrexate

Question 27

Vit B12

Answer 27

Cobalamin Cofactor for methionine synthase: transfer of methyl group onto homocysteine --> methionine Found ONLY in animal products--vegans beware!

Question 28

Vit B12 deficiency

Answer 28

Malabsorption: diphyllobothrium Latum, Sprue, enteritis Lack of intrinsic factor: pernicious anemia, gastric bypass surgery Absence of terminal ileum: surgical resection for Crohn's disease insufficient intake: vegans

Question 29

Vit B12 deficiency s/s

Answer 29

Macrocytic, megaloblastic anemia Hypersegmented neutrophils Paresthesias and SUBACUTE COMBINED DEGENERATION Increased homocysteine and MMA

Question 30

Vit C

Answer 30

Antioxidant Hydroxylation of proline and lysine in collagen synthesis Dopamine beta hydroxylase: concerts dopa to NorE

Question 31

Vit C use

Answer 31

TX for methemoglobinemia : Fe3-->Fe2 (binds Oxygen, FERROUS)

Question 32

Vit C deficiency

Answer 32

Scurvy: swollen gums, bruising, HEMARTHROSIS, peri follicular hemorrhages, corkscrew hair, Weakened immune response

Question 33

Vit C Goljan

Answer 33

old person on "tea and toast" diet will be deficient in Vit C

Question 34

Vit C excess

Answer 34

N/v/d | Calcium palate nephrolithiasis -- STONES

Question 35

Vit D

Answer 35

Increase intestinal absorption of calcium and phosphate, increased bone mineralization at low levels, increased bone resorption at higher levels

Question 36

Vit D deficiency

Answer 36

Children: RICKETS, craniotabes-softening of skull bones Adults: osteomalacia Breastfed infants should receive ORAL Vit D

Question 37

Vit D excess

Answer 37

Granulomatous disesae= SARCOID (increased activation of Vit D by epitheliod macrophages) Hypercalcemia/uria = kidney stones! Loss of appetite, stupor

Question 38

Vit E

Answer 38

Tocopherol Antioxidant (protects from free radical damage) ENHANCES ANTICOAGULATION EFFECTS OF WARFARIN

Question 39

Vit E deficiency

Answer 39

Hemolytic anemia, spinocerebellar tract demyelination-neuro presentation similar to Vit B12

Question 40

Vit E toxicity

Answer 40

Prevents Vit K factor synthesis (if patient is also on warfarin, they become EXTREMELY ANTICOAGULATED!!)

Question 41

Vit K

Answer 41

Cofactor for gamma carboxylate on of glutamic acid residues on various proteins required for blood clotting Synthesized by intestinal flora Necessary for protein C, S and factors 10, 9, 7, 2 Warfarin-Vit K antagonist

Question 42

Vit K deficiency

Answer 42

Neonatal hemorrhage with increased PT and PTT, but NORMAL BLEEDING TIME GIVE NEWBORNS VIT K INJECTIONS May also occur after Ab use

Question 43

Goljan Vit K

Answer 43

Rat poison = Vit K | Child gets into grandparent's warfarin= anticoagulated

Question 44

Zinc function and deficiency

Answer 44

Transcription factor motifs Delayed wound healing Old person with abnormal taste and smell, acrodermatitis enteropathica (rash around eyes, mouth, nose and anus)

Question 45

Vitamin A function

Answer 45

Retinal - antioxidant Visual pigments Differentiation of epithelial cells into specialized tissue