Vitamin B12
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Questions and Answers

What are the cells that make free radicals through the enzyme NADPH oxidase?

Neutrophils

What are the symptoms of pancreatitis?

Moans and groans, the most common severe abdominal pain

What is the most common cause of pseudotumor cerebri?

Obesity

What is the main complication of vitamin A excess?

<p>Blindness</p> Signup and view all the answers

What is the treatment for pseudotumor cerebri?

<p>Discontinue vitamin A and perform serial lumbar punctures</p> Signup and view all the answers

What is the best source of Vitamin B2 (Riboflavin)?

<p>Milk</p> Signup and view all the answers

What are the symptoms of Pellagra?

<p>Diarrhea, dermatitis, dementia, and death</p> Signup and view all the answers

What is the treatment for acute gout?

<p>Colchicine</p> Signup and view all the answers

What is the deficiency state for Vitamin B4 (Lipoic Acid)?

<p>None</p> Signup and view all the answers

What is the drug of choice for chronic neuropathy/pain?

<p>Amitriptyline</p> Signup and view all the answers

What is the recommended INR range for patients on warfarin?

<p>2 to 3x normal</p> Signup and view all the answers

What is the treatment duration for warfarin in patients with a first-time venous clot with a known cause?

<p>3 months</p> Signup and view all the answers

What is the most common cause of genetic spontaneous venous clot formation?

<p>Factor V Leiden Mutation</p> Signup and view all the answers

Why is heparin administered before warfarin?

<p>To activate antithrombin III for protection against clots</p> Signup and view all the answers

What is the role of heparin in blocking thrombin and clotting factors?

<p>It acts as a cofactor for antithrombin III</p> Signup and view all the answers

What is the role of enzymes?

<p>To help create energy through all the pathways.</p> Signup and view all the answers

What happens if a vitamin, mineral, or trace element is missing?

<p>It will lead to a low energy state.</p> Signup and view all the answers

What is the function of vitamin A?

<p>Vitamin A is a cofactor for parathyroid hormone function. It stimulates osteoclastic activity, is used for cerebrospinal fluid production, and is used for epithelial cell maturation.</p> Signup and view all the answers

What is the most unique function of vitamin A?

<p>The most unique function of vitamin A is night vision.</p> Signup and view all the answers

What are antioxidants?

<p>Antioxidants are molecules that eat up free radicals, which are made of oxygen and are high energy. Free radicals can cause cells to die or mutate, potentially leading to cancer.</p> Signup and view all the answers

What is the role of calcium in muscle contraction?

<p>Intracellular calcium is needed for all muscle contraction, while smooth muscle uses extracellular calcium for second messenger systems.</p> Signup and view all the answers

Which membranes use calcium to depolarize?

<p>The atrium and thalamus are the only membranes that use calcium to depolarize.</p> Signup and view all the answers

What is the clinical correlation of calcium deficiency in babies in utero?

<p>Babies in utero need calcium for the release of neurotransmitters. If not, they may be born with mental retardation.</p> Signup and view all the answers

What is the role of magnesium in kinases?

<p>Magnesium is a cofactor for all kinases, which make and use negatively charged ATP. It provides a positive charge to hold onto the negative charges.</p> Signup and view all the answers

What is the clinical presentation of copper excess?

<p>Copper excess can result in Wilson's disease, which is characterized by ceruloplasmin deficiency and copper deposition in the lenticular nucleus (basal ganglia), cornea (Kayser-Fleischer rings), and liver (causing cirrhosis).</p> Signup and view all the answers

What is the function of Vitamin B12 in the body?

<p>Vitamin B12 is needed by two enzymes: homocysteine methyltransferase and methyl malonyl-CoA mutase. It is also used to make tetrahydrofolate and recycle odd-numbered carbon fatty acids.</p> Signup and view all the answers

What are the symptoms of Vitamin B12 deficiency?

<p>Symptoms of Vitamin B12 deficiency include megaloblastic anemia, hyper segmented neutrophils, and neuropathy, especially involving the dorsal column pathways and corticospinal tracts.</p> Signup and view all the answers

What is the most common cause of Vitamin B12 deficiency in the US?

<p>The most common cause of Vitamin B12 deficiency in the US is pernicious anemia (type A gastritis).</p> Signup and view all the answers

What is the main function of Vitamin C in the body?

<p>Vitamin C is used for hydroxylation, specifically hydroxylating proline and lysine in collagen and elastin. It is also the main antioxidant in the GI system.</p> Signup and view all the answers

What are the symptoms of Vitamin C deficiency?

<p>Symptoms of Vitamin C deficiency include scurvy and bleeding from hair follicles and gums.</p> Signup and view all the answers

What is the role of vitamins, minerals, and trace elements in enzymes?

<p>They play the biggest role in enzymes.</p> Signup and view all the answers

What is the role of enzymes?

<p>To help create energy through all the pathways.</p> Signup and view all the answers

What happens if a vitamin, mineral, or trace element is missing?

<p>It will lead to a low energy state.</p> Signup and view all the answers

What is the most unique function of vitamin A?

<p>Night vision.</p> Signup and view all the answers

What is the most common cause of free radical formation?

<p>Virus</p> Signup and view all the answers

What are the cells that make free radicals via the enzyme NADPH oxidase?

<p>Neutrophils</p> Signup and view all the answers

What is the most common cause of pseudotumor cerebri?

<p>Obesity</p> Signup and view all the answers

What are the signs of increased intracranial pressure in Wernicke's encephalopathy?

<p>Papilledema</p> Signup and view all the answers

What are the four important enzymes that require thiamine?

<ol> <li>Pyruvate dehydrogenase, 2. Alpha-ketoglutarate dehydrogenase, 3. Branched chain amino acid dehydrogenase, 4. Transketolase</li> </ol> Signup and view all the answers

What is the role of heparin in blocking thrombin and clotting factors?

<p>To prevent blood clot formation</p> Signup and view all the answers

What is the role of Vitamin E in the body?

<p>Vitamin E is the main antioxidant in the blood and absorbs free radicals.</p> Signup and view all the answers

What is the function of Vitamin K in the body?

<p>Vitamin K is needed for gamma-carboxylation and adds a third carboxyl group to the vitamin K dependent clotting factors.</p> Signup and view all the answers

What is the deficiency state for Vitamin D?

<p>Vitamin D deficiency can cause rickets in children and osteomalacia (soft bones) in adults.</p> Signup and view all the answers

What are the symptoms of Vitamin C deficiency?

<p>Vitamin C deficiency can cause scurvy, with symptoms such as bleeding from hair follicles and gums.</p> Signup and view all the answers

What is the role of Biotin in the body?

<p>Biotin is necessary for carboxylation and deficiency can result in loss of function of many carboxylases.</p> Signup and view all the answers

What is the function of Vitamin B5 (Pantothenic Acid) in the body?

<p>Needed by Pyruvate dehydrogenase, Alpha ketoglutarate dehydrogenase, Branched chain amino acid dehydrogenase, and Coenzyme A. No deficiency states.</p> Signup and view all the answers

What is the function of Vitamin B6 (Pyridoxine) in the body?

<p>Needed to make heme and by all transaminases.</p> Signup and view all the answers

What is the clinical correlation of Niacin deficiency?

<p>Pellagra: 4 D’s - Diarrhea, dermatitis, dementia, and death. Hartnup’s Disease presents just like pellagra.</p> Signup and view all the answers

What is the management for acute gout?

<p>Most effective treatment: colchicine. Current treatment: indomethacin. In case of renal failure, locally inject with an IV steroid (because colchicine and indomethacin are renally excreted).</p> Signup and view all the answers

What is the clinical correlation of Folate deficiency?

<p>Megaloblastic anemia and neural tube defects in fetuses. Most common cause of neural tube defects: overcooked vegetables.</p> Signup and view all the answers

What is the role of heparin in the management of warfarin?

<p>Heparin is administered before warfarin to activate antithrombin III and provide immediate protection against clot formation while warfarin takes time to reach therapeutic levels.</p> Signup and view all the answers

What is the mechanism of action of heparin?

<p>Heparin acts as a cofactor for antithrombin III and blocks thrombin, as well as clotting factors IX, X, XI, and XII in the intrinsic pathway.</p> Signup and view all the answers

What are the side effects of heparin?

<p>Side effects of heparin include bleeding, hyperlipidemia, and heparin-induced thrombosis (HIT). HIT can occur on day 1 or 2 (HIT-1) or after day 3 (HIT-2).</p> Signup and view all the answers

What is the role of low-molecular weight heparin (LMWH) in the management of clotting disorders?

<p>LMWH is used to decrease the risk of side effects associated with heparin. It has fewer side effects, less bleeding, and does not require monitoring of PTT or PT. It is safe for use during pregnancy.</p> Signup and view all the answers

Why is vitamin K given to newborns?

<p>Vitamin K is given to newborns to prevent hemorrhagic disease of the newborn, which occurs around 2 days old. This is because the half-life of factor VII is 2 days, and newborns have insufficient gut flora to produce enough vitamin K.</p> Signup and view all the answers

What is the role of vitamins, minerals, and trace elements in enzymes?

<p>They play the biggest role in enzymes.</p> Signup and view all the answers

What is the role of enzymes?

<p>To help create energy through all the pathways.</p> Signup and view all the answers

What is the most common cause of free radical formation?

<p>Radiation therapy.</p> Signup and view all the answers

What are free radicals?

<p>High energy molecules made of oxygen.</p> Signup and view all the answers

What happens if cells are exposed to free radicals?

<p>They either die or mutate, potentially causing cancer.</p> Signup and view all the answers

What are the symptoms of Riboflavin deficiency?

<p>Angular cheilosis.</p> Signup and view all the answers

What are the symptoms of Pellagra?

<p>Diarrhea, dermatitis, dementia, and death.</p> Signup and view all the answers

What is the treatment for acute gout?

<p>The most effective treatment for acute gout is colchicine.</p> Signup and view all the answers

What is the deficiency state for Vitamin B4 (Lipoic Acid)?

<p>There is no deficiency state for Vitamin B4 (Lipoic Acid).</p> Signup and view all the answers

What are the symptoms of Wernicke's encephalopathy?

<p>Signs of increased intracranial pressure (ICP)</p> Signup and view all the answers

What is the main complication of Vitamin A excess?

<p>Blindness</p> Signup and view all the answers

What are the symptoms of Pseudotumor cerebri?

<p>Headache, papilledema</p> Signup and view all the answers

What are the symptoms of Beriberi?

<p>Dry beriberi: heart failure; Wet beriberi: fluid in the lungs, massive ventricular dilation</p> Signup and view all the answers

What are the four important enzymes that require Thiamine?

<ol> <li>Pyruvate dehydrogenase 2. Alpha-ketoglutarate dehydrogenase 3. Branched chain amino acid dehydrogenase 4. Transketolase</li> </ol> Signup and view all the answers

What is the mechanism of action of warfarin?

<p>Warfarin inhibits the synthesis of vitamin K-dependent clotting factors (Factors II, VII, IX, and X) by inhibiting the enzyme vitamin K epoxide reductase.</p> Signup and view all the answers

What is the role of heparin in the management of warfarin?

<p>Heparin is used initially to rapidly anticoagulate patients until the warfarin takes effect. It is also used during the transition period when switching from heparin to warfarin.</p> Signup and view all the answers

What is the difference between HIT-1 and HIT-2?

<p>HIT-1 is characterized by platelet clumping and occurs within the first 1-2 days of heparin therapy. HIT-2 is characterized by thrombocytopenia and occurs after 3 or more days of heparin therapy.</p> Signup and view all the answers

What are the pros of using low-molecular weight heparin (LMWH) over unfractionated heparin?

<p>LMWH has fewer side effects, less bleeding, lower cost, and does not require monitoring of PTT or PT. It is also safe for use during pregnancy.</p> Signup and view all the answers

Why is vitamin K given to newborns?

<p>Vitamin K is given to newborns to prevent hemorrhagic disease of the newborn, which occurs around 2 days after birth. This is because the half-life of Factor VII, a vitamin K-dependent clotting factor, is 2 days.</p> Signup and view all the answers

What is the role of Vitamin B12 in the body?

<p>Vitamin B12 is needed by two enzymes: Homocysteine methyltransferase and Methyl malonyl-CoA mutase. It is also used to recycle odd-numbered carbon fatty acids and to make tetrahydrofolate.</p> Signup and view all the answers

What are the clinical manifestations of Vitamin B12 deficiency?

<p>Vitamin B12 deficiency can cause megaloblastic anemia, hyper segmented neutrophils, and neuropathy, especially involving the dorsal column pathways and corticospinal tracts.</p> Signup and view all the answers

What is the cause of Vitamin D deficiency and what are the associated clinical presentations?

<p>Vitamin D deficiency can be caused by obesity. In children, it can cause rickets, characterized by lateral bowing of the legs. In adults, it can cause osteomalacia, characterized by soft bones.</p> Signup and view all the answers

What is the main function of Vitamin E in the body?

<p>Vitamin E is the main antioxidant in the blood and it absorbs free radicals. It is used to treat diseases involving oxidation such as cancer, Alzheimer's disease, coronary artery disease, and hemolytic anemia.</p> Signup and view all the answers

What is the function of Vitamin K in the body?

<p>Vitamin K is needed for gamma-carboxylation, which adds a third carboxyl group to the vitamin K dependent clotting factors. This allows them to be attracted to calcium and participate in blood clotting.</p> Signup and view all the answers

What are the functions of calcium in muscle contraction?

<p>Calcium is needed for all muscle contraction, including smooth muscle contraction, which uses extracellular calcium for second messenger systems. The atrium and thalamus are the only membranes that use calcium to depolarize, and the cardiac ventricle depends on extracellular calcium to trigger its intracellular calcium release through 'Calcium-induced calcium release'.</p> Signup and view all the answers

What are the clinical correlations of calcium deficiency in babies in utero?

<p>Babies in utero need calcium for the release of neurotransmitters. If not provided, they may be born with mental retardation.</p> Signup and view all the answers

What are the functions of zinc in the body?

<p>Zinc is needed by hair, skin, sperm, and taste buds. Its deficiency can cause dysgeusia, which is a distortion of the sense of taste.</p> Signup and view all the answers

What are the functions of copper in the body?

<p>Copper is needed by lysine oxidase in the formation of collagen and by complex IV of the electron transport system. Excess copper can lead to Wilson's disease, an autosomal recessive disorder characterized by copper deposition in the lenticular nucleus, cornea (Kayser-Fleischer rings), and liver (causing cirrhosis).</p> Signup and view all the answers

What is the role of calcium in muscle contraction?

<p>Calcium is needed for all muscle contraction. Smooth muscle uses extracellular calcium for second messenger systems. The atrium and thalamus are the only membranes that use calcium to depolarize. The cardiac ventricle depends on extracellular calcium to trigger off its intracellular calcium release, known as “Calcium-induced calcium release”.</p> Signup and view all the answers

What are the clinical correlations of calcium deficiency in babies in utero?

<p>Babies in utero need calcium for the release of neurotransmitters. If not, they may be born with mental retardation.</p> Signup and view all the answers

What are the functions of magnesium in the body?

<p>Magnesium is a cofactor for all kinases, which make and use negatively charged ATP. It also acts as a cofactor for PTH. Additionally, it interacts with potassium in the early distal convoluted tubules of the kidneys and serves as a cotransport protein for both potassium and magnesium.</p> Signup and view all the answers

What are the clinical correlations of copper excess?

<p>Copper excess can result in Wilson’s disease, an autosomal recessive condition characterized by ceruloplasmin deficiency. Copper deposition occurs in the lenticular nucleus (basal ganglia), cornea (Kayser-Fleischer rings), and liver (causing cirrhosis). Treatment for Wilson’s disease involves penicillamine, but caution must be taken if the patient has anaphylaxis to penicillin.</p> Signup and view all the answers

What is the function of iron in the body?

<p>Iron is needed for the formation of heme and hemoglobin. Ferrous iron (Fe2+) binds oxygen, while ferric iron (Fe3+) has been oxidized. Additionally, iron is needed by complex III and IV of the electron transport system.</p> Signup and view all the answers

What are the functions of calcium in muscle contraction?

<p>Calcium is needed for all muscle contraction, and smooth muscle uses extracellular calcium for second messenger systems. The atrium and thalamus are the only membranes that use calcium to depolarize. The cardiac ventricle depends on extracellular calcium to trigger off its intracellular calcium release, known as 'calcium-induced calcium release'.</p> Signup and view all the answers

What is the role of magnesium in the body?

<p>Magnesium is a cofactor for all kinases, which make and use negatively charged ATP. It is also a cofactor for PTH and interacts with potassium in the early distal convoluted tubules of the kidneys. Additionally, magnesium acts as a cotransport protein for both potassium and magnesium.</p> Signup and view all the answers

What are the functions of zinc in the body?

<p>Zinc is needed by hair, skin, sperm, and taste buds. A deficiency in zinc can lead to dysgeusia, which is a distortion of the sense of taste.</p> Signup and view all the answers

What is the role of copper in the body?

<p>Copper is needed by lysine oxidase in the formation of collagen and by complex IV of the electron transport system.</p> Signup and view all the answers

What is Wilson's disease and how is it managed?

<p>Wilson's disease is an autosomal recessive condition characterized by ceruloplasmin deficiency and copper deposition in the lenticular nucleus, cornea (Kayser-Fleischer rings), and liver (causing cirrhosis). It can be managed with penicillamine, which binds to copper and other 2+ cations. However, caution should be exercised if the patient has anaphylaxis to penicillin.</p> Signup and view all the answers

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