Vitamins and Minerals

Question 1

Neurological symptoms, acrodynia (peeling of fingertips), enlarged spleen, abdominal pain after eating lots of large fish

Answer 1

Mercury poisoning

Question 2

Common sources of mercury poisoning

Answer 2

shark, tilefish, king mackerel, swordfish

Question 3

Decreased IQ, growth impairment, hearing problems, abdominal pain, encephalopathy, peripheral neuropathy (wrist and foot drop), blue lines on gums, basophilic stippling on smear, ringed sideroblasts

Answer 3

Lead poisoning

Question 4

Treatment for lead poisoning

Answer 4

succimer, EDTA

Question 5

Nausea, vomiting, gastric bleeding (possibly), metabolic acidosis, eventual scarring leading to GI obstruction

Answer 5

iron poisoning

- commonly kid consuming too many of mom’s prenatal vitamins

Question 6

Treatment for iron poisoning

Answer 6

chelation with deferoxamine

Question 7

Delayed wound healing, hypogonadism (leading to infertility), decreased body and pubic hair growth, dysgeusia, anosmia, acrodermatitis enteropathica (rash around eyes, mouth, nose, anus)

Answer 7

Zinc deficiency

-zinc is needed for zinc fingers –> allows transcription factors to bind, therefore required during times of high cell turnover like healing

Question 8

Signs of hypocalcemia

Answer 8

Trousseau - tighten BP cuff and hand cramps up

Chvostek - stroke cheek and facial muscles twitch

Question 9

Signs of hypercalcemia

Answer 9

Stones - kidney stones
Bones - bone pain
Moans - abdominal pain
Groans - weakness, confusion, lethargy

Question 10

Different forms of Vit D and their sources

Answer 10

D2 - plants
D3 - milk, sun-exposure

25-OH D3 = storage form (what is measured on labs, made by 25-hydroxylase in liver)
1,25-OH2 D3 = active form (made by kidney by 1alpha-hydroxylase)

Question 11

Bone tenderness, bowing of legs, tooth problems, muscle weakness, tetany

Answer 11

Vit D deficiency (Rickets in kids, osteomalacia in adults)

Question 12

Hypercalcemia, hypercalciuria, loss of appetite, stupor, can be seen with Sarcoidosis

Answer 12

Vit D excess - leads to high calcium

Sarcoid - macs increase activation of Vit D

Question 13

Hemolytic anemia, muscle weakness, ataxia

Answer 13

Vit E deficiency

ataxia due to posterior column and spinocerebellar tract demyelination

Question 14

Function of Vit E

Answer 14

antioxidant - protects RBCs from free radical damage

Question 15

Epistaxis, hematoma, GI bleeding, easy bruising, can be associated with recent broad-spectrum Abx use

Answer 15

Vit K deficiency

-due to abx, fat malabsorption (CF pts), warfarin, phenytoin

Question 16

Function Vit K

Answer 16

cofactor for gamma-carboxylation of glutamic acid residues on various proteins required for blood clotting, synthesize by intestinal flora (MICRO = AWESOME)

Factors 2, 7, 9, 10, Protein S and C

Question 17

What are neonates given IM Vit K shot at birth?

Answer 17

neonates have sterile intestines and can’t produce Vit K - can result in neonate hemorrhage (increased PT and PTT)

Question 18

Swollen gums, loose teeth, brusing, petechiae, hemarthrosis, anemia, poor wound healing, corkscrew hair

Answer 18

Vit C deficiency

Question 19

Function of Vit C

Answer 19

antioxidant, facilitates iron absorption by keeping iron in Fe2+ state, hydroxylation of proline and lysine residues on collagen, needed by dopamine beta-hydroxylase which converts dopamine to NE

Question 20

What collagen residues are hydroxylated with the help of Vit C?

Answer 20

proline, lysine

Question 21

Night blindness (nyctalopia), dry, scaly skin (xerosis cutis), corneal degeneration (keratomalacia), bitot spots on conjunctiva

Answer 21

Vit A deficiency

Question 22

N/V, vertigo, blurred vision, alopecia, dry skin, hepatic toxicity and enlargement, arthalgias, pseudotumor cerebri (increased ICP), teratogenic

Answer 22

Vit A excess

Question 23

Function of vit A

Answer 23

antioxidant, visual pigments (retinal), differentiation of epithelial cells

Question 24

What diseases can be treated with Vit A?

Answer 24

acne, wrinkles, measles, AML-M3

Question 25

Cofactor for pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, transketolase, branched-chain ketoacid dehydrogenase

Answer 25

thiamine (Vitamin B1) - needed to be able to breakdown glucose for fuel for brain activated form is thiamine pyrophosphate (TPP)

Question 26

Presents as either dry beriberi, wet beriberi, or Wernicke-Korsakoff

Answer 26

Thiamine (B1) deficiency

Question 27

encephalopathy/confusion, ataxia, ophthalmoplegia

Answer 27

Wernicke -seen in malnourished or alcoholics

Question 28

encephalopathy/confusion, ataxia, ophthalmoplegia + confabulation, personality changes, memory loss

Answer 28

Wernicke-Korsakoff syndrome -most commonly seen in Alcoholics

Question 29

What is damaged in Wernicke-Korsakoff syndrome?

Answer 29

medial dorsal nucleus of the thalamus, mammillary bodies (also see general cerebral atrophy)

Question 30

Treatment for thiamine (B1) deficiency

Answer 30

thiamine supplemented followed by glucose - will see increase in RBC transketolase activity

Question 31

polyneuritis, peripheral neuropathy, symmetrical muscle wasting in a malnourished person or alcoholic

Answer 31

Dry beriberi - affects nerves

Question 32

high-output cardiac failure, dilated cardiomyopathy, peripheral vasodilation, edema in a malnourished person or alcoholic

Answer 32

Wet beriberi - affects heart

Question 33

Cheilosis, glossitis, corneal vascularization

Answer 33

Vit B2 deficiency (riboflavin)

Question 34

Cofactor for redox reactions (dehydrogenase rxn)

Answer 34

``` Vitamin B2 (riboflavin) - component of FAD and FMN Vitamin B3 (niacin) - component of NAD, NADP ```

Question 35

Presents with dermatitis, diarrhea, dementia (pellegra)

Answer 35

Vitamin B3 deficiency (niacin) Hartnup disease - deficiency of neutral AA transport (can't absorb tryptophan) Malignant carcinoid syndrome - increase tryp metabolism Isoniazid

Question 36

What vitamin is derived from tryptophan?

Answer 36

niacin

Question 37

What is niacin used to treat and what is the main side effect?

Answer 37

hyperlipidemia - lowers LDL, raises HDL | SE = facial flushing

Question 38

What vitamin is a component of coenzyme A?

Answer 38

Vitamin B5 (pantothenic acid) deficiency - dermatitis, enteritis, alopecia, adrenal insufficiency

Question 39

Presents with convulsions, hyperirritability, peripheral neuropathy, sideroblastic anemia, glossitis, cheilosis

Answer 39

Vitamin B6 deficiency (pyridoxine)

Question 40

Cofactor for transamination and deaminations (transferring amino groups), needed by ALT/AST

Answer 40

Vitamin B6 - pyridoxal phosphate is active form

Question 41

What compounds are synthesized by using Vitamin B6 (pyridoxal phosphate)?

Answer 41

GABA (def. leads to seizures), dopamine, NE, epi, serotonin, cystathione, heme, niacin, histamine

Question 42

Cofactor for carboxylation (CO2 to add 1 carbon)

Answer 42

Vitamin B7 (biotin)

Question 43

What two things can cause a biotin deficiency and dermatitis, alopecia, enteritis?

Answer 43

eating raw egg whites, antibiotic use

Question 44

What vitamins are important for the synthesis of DNA and RNA?

Answer 44

Vitamin B9 (folate), Vitamin B12 (cobalamin)

Question 45

What vitamin is needed for 1-carbon transfers/methylation, DNA and RNA synthesis by producing bases?

Answer 45

Vitamin B9 - folate (active form is tetrahydrofolic acid)

Question 46

Most common vitamin deficiency in US

Answer 46

folate - found in green leafy vegetables

Question 47

Megaloblastic anemia, hypersegmented neutrophils, glossitis, no neuro symptoms

Answer 47

folate deficiency - can be caused by drugs (phenytoin, SMP-TMX, Mtx) or pregnancy or alcoholism

Question 48

Megaloblastic anemia, hypersegmented neutrophils, parathesias (degeneration of dorsal columns, lateral corticospinal tracts, spinocerebellar tracts)

Answer 48

Vitamin B12 (cobalamin) deficiency prolonged def. can lead to irreversible nerve damage

Question 49

What vitamins are made microbes?

Answer 49

``` Vitamin K (in our guts) Vitamin B12 (synthesized by microbes in animals) ```

Question 50

Causes of Vitamin B12 deficiency

Answer 50

malabsorption in terminal ileum - celiac, enteritis, diphyllobothrium latum lack of intrinsic factors (pernicious anemia, gastric bypass) absence of terminal ileum (surgical resection for Chron's) insufficient intake (vegan)

Question 51

What is diagnostic for pernicious anemia?

Answer 51

anti-intrinsic factor antibodies