P3 (Calcium to Copper)

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[Calcium] The majority of calcium is found in _ _ _ _ _, _ _ _ _ _, and _ _ _ _ _.

bone
teeth
cartilage

[Calcium] Extracellular concentration of calcium is _ _ _ _ _.

rigidly controlled

[Calcium] For some diseases, what doctors want is not the total serum calcium, but the ionized calcium as it is the _ _ _ _ _.

one circulating unbound in the plasma

[Calcium] Calcium is rigidly controlled because of toxicity which can cause _ _ _ _ _ and even at low doses, calcium can produce _ _ _ _ _.

cardiac failure
arrhythmias

[Calcium] Prolonged elevation of intracellular calcium is _ _ _ _ _.

toxic

[Calcium] Phytic acid in cereals binds calcium in the _ _ _ _ _ and supposedly _ _ _ _ _ calcium absorption.

intestinal lumen
hinders

[Calcium] The side effects of calcium include:

• * _ _ _ _ _

Constipation
Bloating

[Calcium] Plasma calcium concentration is maintained within narrow limits, between _ _ _ _ _ and _ _ _ _ _ mmol/L (_ _ _ _ – _ _ _ _ mg/dL).

2.20
2.60
8.8
10.4

[Calcium] Ionized calcium is the most important, physiologically _ _ _ _ _ form, constituting _ _ _ _ _% of total plasma calcium.

active
50

[Calcium] Most of the remaining calcium (after ionized) is protein bound, mainly to negatively charged _ _ _ _ _ (_ _ _ _ _%).

albumin
40

[Calcium] The rest of calcium (10%) is complexed to compounds such as _ _ _ _ _ and _ _ _ _ _.

citrate
phosphate

[Calcium] Calcium is absorbed in the _ _ _ _ _ and is excreted in _ _ _ _ _ and _ _ _ _ _.

small intestine
urine
feces

[Calcium] Calcium absorption in the proximal small intestine is regulated by its quantity in the diet and by two cellular calcium transport processes:

• The active, _ _ _ _ _ transcellular absorption stimulated by _ _ _ _ _.
• Nonsaturable _ _ _ _ _ absorption controlled by the concentration of calcium in the _ _ _ _ _ relative to the plasma.

saturable
1,25(OH)2D3
paracellular
intestinal lumen

[Calcium] PTH promotes calcium reabsorption acting on the _ _ _ _ _.

proximal renal tubules

[Calcium] In Hypercalcemia:

• Renal calcium filtration is _ _ _ _ _
• Tubular reabsorption is _ _ _ _ _

increased
inhibited

[Calcium] Hypocalcemia results in a reduction in urinary excretion, mainly as a result of _ _ _ _ _.

decreased amounts of filtered calcium

[Calcium] Calcium reabsorption is _ _ _ _ _ in hypoparathyroidism.

reduced

[Calcium] Adrenal and gonadal steroids (estrogen in women, testosterone in men) stimulate _ _ _ _ _ and inhibit _ _ _ _ _ activity.

osteoblasts
osteoclast

[Calcium] Adrenal and gonadal steroids also _ _ _ _ _ intestinal calcium absorption and _ _ _ _ _ renal calcium and phosphate excretion.

increase
decrease

[Calcium] Growth hormone _ _ _ _ _ urinary excretion of calcium and _ _ _ _ _ urinary excretion of phosphate.

increases
decreases

[Calcium Supplements] The percentage of Elemental Calcium in Calcium carbonate is _ _ _ _ _%.

40

[Calcium Supplements] The percentage of Elemental Calcium in Calcium citrate is _ _ _ _ _%.

21

[Calcium Supplements] The percentage of Elemental Calcium in Calcium gluconate is _ _ _ _ _%.

9

[Calcium Supplements] The percentage of Elemental Calcium in Calcium lactate is _ _ _ _ _%.

13

[Calcium Supplements] Take calcium supplements _ _ _ _ _ before taking iron supplements.

2 hours

[Calcium Supplements] It is not advisable to take calcium and iron at the same time because of the _ _ _ _ _.

interference with absorption

[Bisphosphonates] Bisphosphonates are used for _ _ _ _ _ treatment.

osteoporosis

[Bisphosphonates] Bisphosphonates improve bone mineral density by attaching to _ _ _ _ _ on bone, impairing osteoclast's ability to continue bone resorption.

hydroxyapatite binding sites

[Bisphosphonates] Bisphosphonates reduce _ _ _ _ _ fracture risk.

vertebral

[Bisphosphonates] Bisphosphonates should be taken on an _ _ _ _ _.

empty stomach

[Bisphosphonates] When taking Bisphosphonates, the patient should maintain an _ _ _ _ _ position.

upright

[Bisphosphonates] If an upright position is not maintained when taking Bisphosphonates, it can cause _ _ _ _ _ (burns the esophagus).

esophageal complications

[Bisphosphonates] After taking Bisphosphonates, the patient should drink water afterwards, and should be taken before meal to allow sufficient absorption. Patient should not eat for _ _ _ _ _.

an hour

[Magnesium] Magnesium complexes with ATP and is a _ _ _ _ _ for many enzymes.

cofactor

[Magnesium] Magnesium binds to _ _ _ _ _, _ _ _ _ _, _ _ _ _ _, and cell substrates.

proteins
RNA
DNA

[Magnesium] Distribution of Magnesium:

• _ _ _ _ _% is in the bones
• _ _ _ _ _% is in the muscles
• Only about _ _ _ _ _% is in the ECF

60
20
1

[Magnesium] Magnesium deficiency can lead to _ _ _ _ _ and _ _ _ _ _.

tetany
cardiac arrhythmias

[Magnesium] Mostly an _ _ _ _ _ ion.

intracellular

[Magnesium] _ _ _ _ _ is more common than _ _ _ __.

Hypomagnesemia
hypermagnesemia

[Magnesium] Refeeding syndrome occurs in treating anorexic or malnourished patients where patients cannot handle the ions or nutrients in which there would be a body reaction by _ _ _ _ _ and _ _ _ _ _.

nausea
vomiting

[Magnesium] Hypomagnesemia can also develop during drug treatment with cisplatin or immunosuppressants such as _ _ _ _ _ or _ _ _ _ _.

cyclosporin A
gentamicin

[Magnesium] Remembering magnesium deficiency is important as it may lead to or exacerbate _ _ _ _ _ and _ _ _ _ _ or make these conditions resistant to treatment until hypomagnesemia is corrected.

hypocalcemia
hypokalemia

[Manganese] Mn-containing enzymes are mostly located within _ _ _ _ _.

mitochondria

[Manganese] Manganese containing enzymes include:

• _ _ _ _ _ (TCA cycle)
• _ _ _ _ _ & _ _ _ _ _ (Nitrogen metabolism)
• Pyruvate carboxylase & PEPCK (Gluconeogenesis)
• _ _ _ _ _ (Mn-SOD)

Isocitrate dehydrogenase
Glutamate synthetase
arginase
Superoxide dismutase

[Manganese] Manganese is used in _ _ _ _ _ reactions, where it cycles between the _ _ _ _ _ and _ _ _ _ _ oxidation states.

redox
+2
+3

[Selenium] Selenium is a component of _ _ _ _ _, which contains selenocysteine.

selenoproteins

[Selenium] Glutathione peroxidase is a _ _ _ _ _ enzyme.

selenium-dependent

[Selenium] Adequate intake of Selenium is important to maximize _ _ _ _ _ in cells.

antioxidant activity

[Selenium] Selenium is absorbed in the _ _ _ _ _ and excreted in the _ _ _ _ _.

small intestine
urine

[Selenium] Selenium deficiency is associated with a type of cardiomyopathy called _ _ _ _ _.

Keshan disease

[Selenium] Food grown in soil containing high levels of selenium may be _ _ _ _ _.

toxic

[Zinc] The valence shell of Zinc has a _ _ _ _ _ and do not adopt _ _ _ _ _.

full set of electrons
alternate oxidation states

[Zinc] Zinc is not involved in electron transport or even _ _ _ _ _ unlike Fe and Mn.

redox reactions

[Zinc] The human body contains _ _ _ _ _ zinc-containing metalloproteins.

3000

[Zinc] The majority of Zinc proteins are transcription factors and other DNA- and RNA-binding proteins (with domains called _ _ _ _ _).

zinc fingers

[Zinc] Zinc is also a component of metalloenzymes such as:

• * * _ _ _ _ _

carbonic anhydrase
carboxypeptidase
cytosolic superoxide dismutase

[Zinc] Zinc is found in highest concentration in _ _ _ __ foods.

animal-source

[Zinc] Zinc absorption is _ _ _ _ _ by phytates and calcium.

inhibited

[Zinc] Zinc absorption is enhanced by _ _ _ _ _ but increased oral intake interferes with _ _ _ _ _.

protein
copper absorption

[Zinc] Zinc supplementation is helpful in accelerating _ _ _ _ _ and halting disease progression.

wound healing

[Zinc] There are already WHO algorithms for Zinc supplementation in patients who have _ _ _ _ _ or _ _ _ _ _.

chronic diarrhea
acute gastroenteritis

[Zinc] Zinc Finger Motifs provide the _ _ _ _ _ for many transcription factors.

DNA binding domain

[Zinc] One of 4 common motifs for binding of transcription factors are _ _ _ _ _.

Zinc fingers

[Zinc] Other motifs (besides Zinc fingers) for binding of transcription factors include:

• * * _ _ _ _ _

Leucine zipper
Helix-turn-helix
Helix-loop-helix

[Zinc] A single amino acid mutation in either of the 2 Zn fingers in the 1,25(OH)2-D3 receptor protein results in _ _ _ _ _ to the action of this hormone and the clinical syndrome of _ _ _ _ _.

resistance
rickets

[Zinc] Rickets is defined as _ _ _ _ _ in children.

Vitamin D deficiency

[Cobalt] Cobalt is a core component of _ _ _ _ _ (Vitamin B12).

5'-deoxyadenosylcobalamin

[Cobalt] Cobalt is in the center of a _ _ _ _ _ where it acts as a Lewis base to facilitate the transfer of one-carbon, methyl or methylene groups.

tetrapyrrole corrin ring

[Cobalt] The Tetrapyrrole corrin ring is similar to the _ _ _ _ _ that contains iron.

heme ring

[Cobalt] Cobalamins are _ _ _ _ _ (cobalt-containing compounds).

corrinoids

[Cobalt] Cobalamin from food binds to _ _ _ _ _ in the stomach -> dissociates in the duodenum -> cobalamin binds to intrinsic factor -> recognized & internalized by _ _ _ _ _.

haptocorrin
cubilin receptors

[Copper] Copper is an essential component of:

• * * * Cytosolic superoxide dismutase

cytochrome oxidase
dopamine beta hydroxylase
tyrosinase

[Copper] Lysyl oxidase uses Cu to generate _ _ _ _ _ in mature collagen (for collagen formation) and elastin.

crosslinking

[Copper] Copper absorption can be inhibited by excess levels of _ _ _ _ _, resulting in potentially lethal anemia.

Zinc

[Copper] When iron is expelled by macrophages, the copper-containing ferroxidase _ _ _ _ _ oxidizes the expelled ferrous ions back to the ferric form.

ceruloplasmin

[Copper] Copper deficiency or ceruloplasmin deficiency leads to _ _ _ _ _.

iron overload

[Copper] Wilson disease is caused by a mutation in the gene for _ _ _ _ _ which blocks excretion of copper in bile.

copper binding P-type ATPase

[Copper] In Wilson disease, the accumulation of copper occurs in:

• * * * _ _ _ _ _

liver
brain
kidney
red blood cells

[Copper] Wilson disease can be prominently _ _ _ _ _ and may affect the _ _ _ _ _.

neurologic
liver

[Copper] A _ _ _ _ _ is one of the manifestations of Wilson's disease.

Kayser-Fleischer ring

[Copper] Patients who would usually have the Kayser-Fleischer ring manifestation are usually _ _ _ _ _ rather than hepatic-related symptoms of Wilson's disease.

neurologic-related

Would you like me to create a separate "Clinical Correlates" deck focusing specifically on the diseases mentioned (Wilson's, Rickets, Keshan, etc.) to help you review for case-based question