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VITAMIN B12 DEFICIENCY Flashcards

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4475993344Structure B12Corrinoid Ring: 4 pyrrole rings Large cobalt atom in centre0
4475997202How do B12 and folate work together?Methylation cycle. To activate folate: B12 removes and keeps methyl group, which activates B12; methyl cobalamin Both the folate co-enzyme and B12 co-enzyme are available and active for DNA production1
4476012403Recycling of homocysteine?Homocysteine recycling into Methionine is important and needs the donation of the methyl group from folate to B12 in order for homocysteine to convert to Methionine2
4476022882Both deficiency of B12 and folate have serious impact on?Co-enzymes = DNA production Deficiency = inability to produce new cells; RBC (high turnover)3
4476025793Dietary sources of B12Naturally from animal sources only that are protein rich: egg, poultry, meat, shellfish, milk and milk products Also fortified grain products eg) cereals, breads4
4476031358Storage of B12In liver, very good storage 3-5 years5
4476033064RDI of B122.4 micrograms per day (due to high storage)6
4476034462People at risk of B12 deficiency + why?Vegans + vegetarians as most B12 from animal sources (need supplements)7
4476038845Stages of B12 absorption in brief.1. Cbl.P enters stomach. HCl (parietal), Pepsin (chief) cleave protein from Cbl 2. Cbl binds to R-binder protein : haptocorrin --> Hc.Cbl 3. Travels to duoendum. Pancreatic proteases seperate Hc.Cbl, at same time intrinsic factor released (parietal), binds to cobalimin; IF. Cbl. 4. IF.Cbl travels to terminal ileum: brush border receptors for IF. IF.Cbl --> enterocyte. IF seperated from Cbl 5. 20% of Cbl forms holotranscobalimin; goes to cells for DNA production, especially RBC, gut enterocytes (high turnover) 6. 80% forms Hc.Cbl --> travels to liver for storage. Stored for 3-5 years.8
4476066725Recycling of B12?Lose B12 through bile -> Small intestine --> back to liver through enterohepatic circulation9
4476072422Common characteristic of B12 and folate deficiency?MACROCYTIC ANAEMIA -large red blood cells and abnormal/irregular shape -due to decline in DNA --> RBC production10
4476079589IDENTIFYING CHARACTERISTIC OF B12 DEFICIENCYSub-acute combined degeneration of spinal cord, affects brain + periphery. Tingling fingers, neurological problems. Not seen in folate deficiency. possible due to build up of SAM.11
4476088010PEOPLE WHO REQUIRE B12 SUPPLEMENTATIONVegans + Vegetarians: oral supplements B12 malabsorption syndromes eg) pernicious anaemia = intramuscular injections of B1212
4476097147List some Clinical Manifestations seen in B12 deficiency blood counts1. Low hemoglobin (anaemia) 2. Elevated Mean Cell Volume 3. Low reticulocytes13
4476103609General Clinical Manifestations of B12 deficiency ?1. Tingling in fingers, difficulty concentrating, neurological problems 2. Pernicious Anaemia (antibody blood test) 3. Low gastric acid secretion 4. Evidence of autoimmune gastritis (endoscopy) 5. Macrocytic Anaemia; short breath + tiredness14
4476116985REQUIREMENTS TO ABSORB B121. Normal gastric acid secretion (HCl, pepsin) = to break B12 from food protein 2. Normal intrinsic factor (parietal cells) 3. Normal pancreatic secretion: require proteases to break Cbl from haptocorrin 4. Normal ilieal absorptive function (I.F receptors at brush border)15
4476130181PERNICOUS ANAEMIA: PATHOLOGYAutoimmune disease; autoantibodies formed against parietal cells and intrinsic factor. lack of intrinsic factor and parietal cells B12 can't be carried and absorbed to/at terminal ileum16
4476131495COMMON CAUSE OF PERNICOUS ANAEMIA?Autoimmune gastritis; antibodies formed against parietal + i.f17
4476131496NORMAL I.F BUT SMALL INTESTINAL PROBLEM?Surgery: terminal ileum resection Crohn's disease causing inflammation to terminal ileum18
4476307695TEST TO DETERMINE LACK OF INTRINSIC FACTORSchilling Test19
4476307734SCHILLING TEST?Radioisotope Test. Historical.20
4476317584TESTS OF PERNICOUS ANAEMIA + AUTOIMMUNE GASTRITIS1. Antibody Blood test: Parietal Cells Intrinsic Factro 2. Biopsy via endoscopy: see evidence of autoimmune gastritis (may be present, not always assoc. with pernicious anaemia) 3. Evidence of low gastric acid output due to parietal cell damage: WILL HAVE ELEVATED GASTRIN LEVELS IN BLOOD ; tries to stimulate acid secretion 4. Evidence of other autoimmune disease eg) thyroid21
4476336801PROBLEMS WITH ANTIBODY BLOOD TESTS?Antibody to parietal: healthy + non healthy have Antibody to IF: all with it will have perc. anaemia but some with perc anaemia don't have it at all22
4476346463TREATMENT FOR NON MAL ABSORPTION B12 DEFICIENCY eg) vegans, poor dietSupplements 1000mcg/week, for 4-6 weeks 1000mcg every 3 months23
4476349362TREATMENT FOR MAL ABSORPTION B12 DEFICIENCYParenteral (intramuscular) injections. As absorption in GI tract = ineffective eg) pernicious anaemia, terminal ileal resection24
4476360697MONITOR B12 REPLACEMENT?-Check B12 Levels -Increase in hemoglobin + reticulocyte response -Resolution of neurological problems25
4476365327EFFECTS OF DISTAL ILEAL RESECTION?Failure to absorb B12 (no specialised IF receptors) Fail to reabsorb bile salts (diarrohea)26
4476375725PARTIAL DISTAL GASTRECTOMY x2Billroth 1 operation Billroth 2 operation Remove distal antrum + proximal duodenum27
4476381864Billroth 1 operation1. distal antrum + proximal duo. removed 2. Joined back end to end 3. Common bile duct and main pancreatic duct is left in position (in situ)28
4476387272Billroth 2 operation1. distal antrum + proximal duodenum removed 2. Not joined. Duodenum sewn shut. 3. Common Bile Duct and Main pancreatic Duct and distal stomach --> sewn/attached to jejunum29
4476399473WHY WOULD THERE BE A LOW B12 AFTER PARTIAL GASTRECTOMY1. No Antrum --> no G Cells --> no Gastrin =reduced gastric acid secretion: Cbl not released from food = reduced pancreatic secretion (stim. acinar cells) = Cbl not released from haptocorrin 2. Bile reflux from small intestine -> atrophic gastritis 3.Atrophic gastritis --> chronic inflammation --> lost of parietal cells --> low IF, low HCl30
4476420033OTHER CAUSES OF LOW B12Celiac disease Terminal Ileal Disese (crohn's) Bacterial Overgrowth Chronic pancreatitis (low p. enzymes) Total gastrectomy Omeprazole, Metformin31
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Detailed American Elections Flashcards

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55252992071976Winner - Jimmy Carter (D) Loser - Gearld Ford (R) 3rd Party- Ronald Reagan0
55252992081980Winner - Ronald Reagan (R) Loser - Jimmy Carter (D) 3rd Party- John B. Anderson (I)1
55252992091984Winner - Ronald Reagan (R) Loser - Walter Mondale (D) 3rd Party- John B. Anderson (I)2
55252992101988Winner - George H.W. Bush (R) Loser - Michael Dukakis (D) 3rd Party- Llyod Bentsen Jr (D) VP Candidate3
55253021921992Winner - Bill Clinton (D) Loser - George H.W. Bush (R) 3rd Party- Ross Perot (I)4
55253021931996Winner - Bill Clinton (D) Loser - Bob Dole (R) 3rd Party- Ross Perot (I)5
55253089382008Winner - Barack Obama (D) Loser - John McCain (R) 3rd Party- Ralph Nader (I)6
55314829482000Winner - George H Bush (R) Loser - Al Gore (D) 3rd Party - Ralph Nader (G)7
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American Pageant Chapter 20 Flashcards

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5624785854William Sewardwas Lincoln's enemy; Lincoln put him in his cabinet to make friends with him; became secretary of state0
5624785855Fort Sumter1st shots of the war on April 12, 1861; the north surrendered after 36 hours; no one was killed in this battle1
5624785857submissionistsnickname to white southerners who wanted to side with the north2
5624785858Richmond, VAends up to be the captial of the Confederacy3
5624785859Butternut Regionsouthern part of the north, sympathetic to the south4
5624785860Billy Yanknorthern soldier5
5624785861Johnny Rebsouthern soldier6
5624785863King Wheat and King CornEurope began to need food instead of cotton; the North had what they needed7
5624785865Alabamaship that escaped to the Portuguese Azores and got weapons; Britain was the chief naval base for the Condeferacy, sunk northern ships, made in Britain, and sunk in France8
5624785867MaximillianFrenchman who took over Mexico in 1863, ignored Monroe Doctrine, Mexico overthrew him9
5624785869Limits on civil liberties1. Proclaimed blockade of southern ports. 2. Ordered to increase army 3. Spent unapproved money on weapons 4. Suspended Habeus Corpus 5. Supervised Voting 6. Suspended newspaper10
5624785870$300 menrich men who didn't want to fight could pay money to have these poorer men fight for them11
5624785871Morrill Acthighest tariff in history, no southerners were in congress to keep it lower12
5624785872Greenbacksmoney that's not worth i, $450 million was not backed up and this unvalueable paper money was floating around America13
5624785874shoddy millionairespeople in the north who made cheap war materials for more money14
5624785875Elizabeth Blackwell1st female physician who started the U.S. Sanitary commission.15
5624785876Clara Bartonmost famous nurse from Civil War; will alter start the Red Cross16
5624785877Dorothea Dixhead nurse of all nurses in Union Army17
5624785878Sally Tompkinsmost famous southern nurse, became a Captain in Confederate Army18
5624785879Charles Francis AdamsUnion ambassador in England; kept England from helping the South19
5684163297arbitrationThe settling of disputes (especially labor disputes) between two parties by an impartial third party, whose decision the contending parties agree to accept.20
5684175752profiteermake or seek to make an excessive or unfair profit, especially illegally or in a black market.21
5684181897Edwin Stantonsecretary of war during civil war who was lenient to the south during reconstruction22
5684186864Jefferson DavisPresident of the Confederate States of America23
5684186865Trent AffairU.S. navy illegally captured two Confederate diplomats from a British ship; the UK protested24
5684191398Draft Riotsclass tensions between rich and poor because only some could dodge the draft25
5684194484Napoleon IIIemperor of France 1852-1870 with sympathies to the South26
5684199043Coal oil Johnniespioneers pushing westward for oil plutocracy27
5684199044wage slavespeople working for unfair compensation in factories28
5684203261cotton famineshortage of cotton due to Union blockade29
5684206065invasions of canadaConfederates attempted to set up base in Canada due to strategic location???30
5684211194writ of habeas corpusLincoln suspended this, allowing holding of people in jail without trial, increased size of military, and shut down newspapers in the capital that were critical of the government31
5684217225bounty brokers/jumperspeople who would persuade men to enlist by giving a sum of money/ attempted to make profit off of conscription32
568421722659ersgold seekers in western kansas and southwestern nebraska33
5684221580Homestead Act of 1862Offered large tracts of land at low prices to encourage westward settlement34
5684226602government girlscivil war version of rosie the riveter35
5684226603plutocracygovernment of the wealthy36
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American Pageant Chapter 20 Flashcards

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5590119384charles francis adamsMinister to Great Britain during the Civil War, he wanted to keep Britain from entering the war on the side of the South.0
5590119385sally tompkinsEstablished a hospital for soldiers in Richmond, Virginia1
5590119386clara bartonNurse during the Civil War; started the American Red Cross2
5590125532maximilianarchduke, installed by napoleon as emperor of mexico3
5590119387napolean IIIdispatched french army to mexico, installed maximillion as leader, breaking monroe doctrine.4
5590119388jefferson davisAn American statesman and politician who served as President of the Confederate States of America for its entire history from 1861 to 1865, poor leader5
5590119389elizabeth blackwellA woman who challenging the taboo of professional women. She graduated from medical college, thereby proving that women are able to do what men can. trained nurses for union army dueing civil war6
5590119390Fort SumterSouth Carolina location where Confederate forces fired the first shots of the Civil War in April of 1861, after Union forces attempted to provision the fort.7
5590119391Border StatesFive slave states-Missouri, Kentucky, Maryland, Delaware, and West Virginia-that did not secede during the Civil War. To keep the states in the Union, Abraham Lincoln insisted that the war was not about abolishing slavery but rather protecting the Union.8
5590119392West Virginia (admitted to the Union 1863)Mountainous region that broke away from Virginia in 1861 to form its own state after Virginia seceded from the Union. Most of the residents of West Virginia were independent farmers and miners who did not won slaves and thus opposed the Confederate cause.9
5590119393Trent Affair (1861)Diplomatic row that threatened to bring the British into the Civil War on the side of the Confederacy, after a Union warship stopped a British steamer and arrested two Confederate diplomats on board.10
5590119394Alabama (1862-1864)British-built and manned Confederate warship that raided Union shipping during the Civil War. One of many built by the British for the Confederacy, despite Union protests.11
5590119395Laird rams (1863)Two well-armed ironclad warships constructed for the Confederacy by a British firm. Seeking to avoid war with the United States, the British Government purchased two ships for its Royal Navy instead.12
5590119396Dominion of Canada (1867)Unified Canadian government created by Britain to bolster Canadians against potential attacks or overtures from the United States.13
5590119397Writ of habeas corpusPetition requiring law enforcement officers to present detained individuals before the court to examine the legality of the arrest. Protects individuals from arbitrary state action. Suspended by Lincoln during the Civil War.14
5590119398New York draft riots (1863)Uprising, mostly of working-class Irish-American, in protest of the draft. Rioters were particularly incensed by the ability of the rich to hire substitutes or purchase exemptions.15
5590119399Morrill Tariff Act (1861)Increased duties back up to 1846 levels to raise revenue for the Civil War.16
5590119400GreenbacksPaper currency issued by the Union Treasury during the Civil War. Inadequately supported by gold, greenbacks fluctuated in value throughout the war, reaching a low of 39 cents on the dollar.17
5590119401National Banking System (1863)Network of member banks that could issue currency against purchased government bonds. Created during the Civil war to establish a stable national currency and stimulate the sale of war bonds.18
5590119402Homestead Act (1862)A federal law that gave settlers 160 acres of land for about $30 if they lived on it for five years and improved it by, for instance, building a house on it. The act helped make land accessible to hundreds of thousand of westward-moving settlers, but many people also found disappointment when their land was infertile or they saw speculators grabbing up the best land.19
5590119403U.S. Sanitary Commission (1861)Founded with the help of Elizabeth Blackwell, the government agency trained nurses, collected medical supplies, and equipped hospitals in an effort to help the Union Army. The omission helped professionalize nursing and gave many women the confidence and organizational skills to propel the women's movement in the postwar years.20
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Elections Flashcards

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4490924711Importance of 3rd PartiesBring issues to national attention0
4490952976Things that influence your political opinionfamily, school, work, friends..1
44909598754 things done at the national nominating conventionparty platform, selecting candidate, VP candidate, speeches2
4490974583Most important factor when choosing a VP running matebring votes3
4491001080mass mediaradio, TV, newspapers, internet, et4
4491003934caucusesmeeting of political party leaders5
4491007738precinctlocal voting district6
4491009811propagandaideas & techniques used to try to influence voters7
4491030527pollswhere you go to vote8
4491033412electoral collegeactual system used to elect the President9
4491035271keynote speakerimportant people who address delegates at the National Convention10
4491047849plankpolitical party's stance on a single issue11
4491049002coalitionwhen 2 or more parties govern together12
4491059586DonkeyDemocrat Party symbol13
4491062306ElephantRepublican Party symbol14
4491069409When General Election isNovember: 1st Tuesday after 1st Monday15
4491080437straight ticketvoting for all the candidates of one political party16
4491135063PrimaryElection a candidate needs to generally win if they want to win the general election17
4491148775George Washingtonnon-partisan; President with no political party18
4491154726TVthe most important mode of media over the last several decades19
4491159894Number of Electors per state= Representatives + Senators20
44911680511st Presidential CaucusIowa21
4491177171important job of political party at all levelsraise money for the candidates22
4491185306GOPGrand Old Party - Republicans23
4491187038DFLMN Democrats24
4491196061Type of Primary in MNopen25
4491200008Most important party committeelocal26
4491203667delegateperson chosen to go to the National Convention27
44912101151st Presidential PrimaryNew Hampshire28
4491213315Why electoral college was set upfeared general public was not educated enough29
4491227376Andrew Jackson1st Democrat President30
4491227378Abraham Lincol1st Republican President31
4491241356major 3rd parties in the USReform, Bull Moose (progressive), Populist, Independence32
4491363228glittering generalitiesvague statements everyone will agree with33
4491363229endorsementsfamous people speaking on behalf of the candidate34
4491363230caucusA meeting of local party members to choose party officials or candidates for public office35
4491364646biasThe subtle presence of a positive or negative approach toward a topic.36
4491364647incumbantPresident already in office running for re-election37
4491385930platforma series of statements expressing the party's principles, beliefs, and positions on election issues38
4491394158Federalistpolitical party that believed in a strong central government39
4498902566more conservative partyRepublican40
4498902567more liberal partyDemocat41
5086032097steps to becoming Presidentdeclare candidacy, campaign, primaries & caucuses, convention, nominee, campaign, election, electoral college, inauguration42
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Unit 2 Week 3 vocab Flashcards

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5456278427candidatesomeone who tries to be elected0
5456282622convincecause a person to believe1
5456286009independentyou do not belong to a political party2
5456292337estimateguess3
5456309681announcedmade something known officially4
5456311417electchoose someone by vote5
5456313629governmentthe group of people who manage a state or country6
5456318586decisionto make up one's mind7
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ap Flashcards

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3499564041location theory0
3499840491sunbelt1
3499954658technopole2
3499984159wallerstein3
3499997856deindustrialize4
3500013517variable costs5
3500026705friction of distance6
3500052815footloose industry7
3500072651global division of labor8
3500101605secularism9
3500115833theocracy10
3500123815pandemic11
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AP Measurement Flashcards

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4803109419matterconsists of individual atoms anything occupying space and having mass, material of universe0
4803109420macroscopic worldthe world that we can see1
4803109421microscopic worldworld of atoms and molecules2
4803109422fundamental concepts of chemistry- matter is composed of various types of atoms - one substance changes to another by reorganizing the way the atoms are attached to each other3
4803109424theoryset of tested hypotheses that gives overall explanation of some natural phenomenon4
4803109426law of conservation of masstotal mass is not affected by chemical change5
4803109427massmeasure of resistance of object to a change in its state of motion6
4803109428weightresponse of mass to gravity, the force7
4803109429accuracyagreement of particular value with the true value8
4803109430precisiondegree of agreement among several measurements of same quantity (reproducibility)9
4803109431random errora measurement has equal probability of being high or low indeterminate error10
4803109432systematic errorsame direction each time, either always high or always low determinate error11
4803109433Significant figuresnonzero integers: always count leading zeros: don't count captive zeros: always count trailing zeros: significant only if # contains decimal point exact numbers: infinite number multiplication and division: #of sig figs in limiting term addition and subtraction: # of decimal places in limiting term12
4803109434metersmeasure of length (IS)13
4803109435kilogramsmeasure of mass (IS)14
4803109436secondsmeasure of time (IS)15
4803109437ampsmeasure of electric current (IS)16
4803109438kelvinmeasure of temperature (IS)17
4803109439candelameasure of luminous intensity (IS)18
4803109440molemeasure of amount of substance (IS)19
4803109441densitymass of a substance per unit volume of the substance a tool for identification of substances20
4803109442solidfixed volume and shape21
4803109443liquiddefinite volume but no specific shape22
4803109444gasno fixed volume or shape23
4803109445homogenous mixturesvisibly indistinguishable parts solutions examples: air, wine, brass24
4803109446heterogeneous mixturesvisibly distinguishable parts examples: sand in water, iced tea with ice25
4803109447pure substanceswith constant composition compounds or elements26
4803109448physical changesa change in the form of a substance, not in its chemical composition examples: boiling, freezing27
4803109449distillationmethod for separating components of mixture depends on differences in volatility (how readily substances become gases)28
4803109450filtrationwhen mixture contains a solid and a liquid29
4803109451chromatographyuses system with 2 states of matter: mobile and stationary30
4803109452compoundssubstances with constant composition that can be broken down into elements by chemical processes31
4803109453chemical changea given substance becomes a new substance or substances with different properties and different composition32
4803109454elementssubstances that can't be decomposed into simpler substances by chemical or physical means33
4803109455Kelvin and Celsius34
4803109456Celsius and Fahrenheit35
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