David A Bender
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One of the delights for a University teacher in June, when the examination papers have to be marked (and medical classes are in excess of 340, so there are a lot of scripts to mark) is seeing how students remember what they thought we said in lectures, and how they express themselves under the stressful conditions of the exam room.
Just occasionally we get a chance to see what students make of our lectures before the exams - some years ago a student came up to me at the end of a lecture on collagen synthesis and gave me these two copies of the handout for the lecture, saying shyly "me and Mandy done this".
My late father started me collecting these "June gems", and indeed some of what follows comes from his collection. From time to time we would phone each other, read out a choice morsel from an exam script, and ask the other one what the question might have been.
Some novel diseases I have learnt about include: divetoseclerosis; photophobia (fear of life); metalablastic anaemia; obesiety; osteosclerosis
A novel metabolic sequence appeared, as far as I know for the first time in 2013, in two universities several hundred miles apart: gluconeolysis.
I am grateful to the many students whose work I have marked over the years, and those I have seen in oral examinations, for the enjoyment the following (sometimes mysterious) quotations have given me:
Man is curious in many ways, like earth, moon, himself.
One can only has at a guess
Optical activity is the activity that can be recognised optically with the eye or the microscope.
These people eat only what they can get.
Thermogenesis law – 1st saying is no-one can get anything from something.
Heisenberg’s law of uncertainty which says you can’t measure anything without loss.
Its usefulness is of more value than its harmfulness.
Because they had no income they were poor.
Q. Why are standard parenteral nutrition bags better than “tailor-made”?
A. Reducing prescribing error. In children, 70% will fit into standard bag. In preterm infants, 90% of them will fit into standard bag. This will be reducing the difficulty in prescribing.
However, at last, after 45 years in the field, I know what nutrition is all about:
"Nutrition is primarily required to meet nutritional requirements"
Some definitions of medical terms
Autosomal recessive genetic disease: when you inherit the genes from your
Diuretic: a blood thinner.
Entero-hepatic circulation: This is when a drug which has already entered the liver re-enters again via the circulation. Therefore taken via circulation to the liver twice.
Entero-hepatic circulation: Despite entering the liver the drug is recirculated around the body without being metabolised.
Entero-hepatic circulation: … is not metabolised by the liver and is passed into the bile. Circulates within the bile between the liver and gall bladder.
Entero-hepatic circulation: The drug is not affected / metabolised in the hepatic system and is therefore allowed to recirculate in the blood.
Gynaecomastia: enzymes in the faeces.
Nocturia: does not sleep at night.
Nocturia: cannot sleep at night due to breathing problems.
Nocturia: darkened urine.
Nocturia: the retention of uria in the bloodstream.
Nystagmus: movement of hte eyes in rsponse to cold and warm water poured into the ear.
Nystagmus: loss of balance.
Nystagmus: the eye moves away from the ear when touched with warm water.
and presumably thinking of nystagmus, one student wrote about "nostalgia to the left or right"
Pregnancy, mother and infant nutrition
The placenta is an organ of display. [When asked about this in a viva the student turned to the lecturer and said “you said it in your lecture”. The student was Iranian, and we subsequently learnt that she meant “transport” – in Pharsee transport and displacement are the same word.]
In the final trimester, which is the third trimester of pregnancy, the growth of the foetus will by then be in the process of completion towards the end. Voluntary food intake by the mother-to-be declines at this time because she has stored all the higher amounts of nutrients that she has consumed in the foetus that is being used up for its growth.
If a child could be made to utilise a higher concentration of milk it is
calculated it could reproduce in two years.
The patient is not the child of one of the parents
A rat who had just given birth was used to feed 3 babies and 18 babies at different times. She had sufficient milk for 12 babies. This gives an idea of the required intake.
A school feeding programme may precipitate early weaning of children. This results in infection of feeding bottles and a higher incidence of pregnancy.
Calcium is very essential during pregnancy. The mother finds the expectant baby in the womb.
For all the food we eat since we were born and if they were all converted to fat we would be obese.
Extracellular cells (4th trimester of pregnancy?).
This required numerous methods, such as the DNA extraction of students
from cheek cells.
It was found that DNA had a base sequence by the human genome project.
. ..denamination of cytosine.
The sickling effect is due to abnormal chromosome coding for the red blood cells.
Electrophoresis: a process of passing an electric current through a solution of genetic information
Appetite is hunger in the presence of satiety
The genetically obese (ob/ob) mouse suffers from an absence of leptin so the appetite inhibition wasn't stimulated
A study showed that food intake was positively correlated with the intake of food
Our eating behavious is controlled by two theories: hunger and appetite.
In the double labelled water method for assessing energy expenditure the subject is submerged under water and energy expenditure is measured there.
The body weight can be assessed by weighing the patient and finding the weight.
If a subject is overweight then (s)he has a greater chance of contracting a disease of the affluence.
The current extent of obesity on the UK in comparison with the past has increased in terms of rate per year.
Obese people will eat what is given, but will also devour anything else they can see.
One method of preventing obesity is to prevent food intake.
A group of normal and obese subjects were asked to remain alive in a room for a few days.
Many people assume that obesity is merely due to greed or bad moral training in upbringing.
The health consequences of obesity are huge.
Obesity in unaesthetically appealing.
...the rationale is that the person becomes bored with eating and does something else instead. This is not very successful.
A group of women were given 5000 calories / day of energy and they consequently gained weight until they stopped and then did not gain any more.
Weight is determined by age expectancy.
Obesity: a high percentage of fat in the body and a high consumption of CO2 which leads to cough.
As a nation we are no longer content to eat enough, preferring in almost all cases to have an extra helping.
Diseases of overnutrition such as dental decay.
Fibre acts as bulk and therefore results in obesity.
The doctor should treat obesity as an uncurable disease.
Allow the obese person to eat as much fat and protein as he desires providing this is not excessive
Since the man is clinically obese this would prove that (because of his obesity) he may be suffering from further complications that are related to obesity.
In some individuals the appetite centre is at fault and they cannot control themselves when they see food.
General physiology, cell biology and metabolism
The colon is a reservoir for food storage
Eukaryotic cells are made up of coding sequences (exons) and non-coding regions (introns)
DNA is compoosed of genes. Genes are a sequence of bases on a strand of DNA.
The liver produces VLDLs which solubilise lipids allowing them to pass to the small intestine where fatty acids and monoglycerides will be dropped off
Another type of therapy [for auto-immune disease] is to remove the patient's plasma and return only the red blood cells.
The cholesterol is not taken up by the liver, so it wanders around in the bloodstream
Macrophages can take up as much cholesterol as they like
If labelled glycine is administered, the only reason for its appearance in urine as labelled urea is that the labelled part has been excreted
Glycine is an amino acid and the 15N is attached to the N part of the NH2 gorup on the amino acid
Hyperammonaemia is a condition where the sufferer is unable to metabolise the ammonia in his body and as the ammonia is toxic this leads to fatal consequences
The urea is normally secreted in bile which passes into bile duct where it is stored and concentrated and passes out into the the urine via kidney
The neuroendocrine reflex is when the function of one gland is dependent on the excretion of another
In bone formation "the osteoclasts then spit out the collagen".
Osteocytes are involved in the reversal phase, whereby mononucleate cells are laid and then indergo differentiation into osteoblasts
Glycogen is usually stored as amylpopectin in humans. It is an arrangement of glucose
Less is known about peroxisomes, but they are fewer in number than lysosomes.
Lysosomes … may also be used in programmed cell death by exploding and destroying the cell.
As the food moves further down the osephagus (sic) it is acted on by pancreatic juice and bile.
Simple constipation is due to low bulk of the food in the colon, which causes high transit time and it produces dry stool (due to lack of water) known as diarrhoea or fatty stool known as steatorrhoea.
Once a patient has entered chronic renal failure the blood creatinine levels slowly rise until a certain level when they require a transplant, haemodialysis or peritoneal dialysis.
Usually, when protein is ingested it can either be used as energy and for extra protein, it will undergo deamination. The products may be used to synthesis (sic) non-essential amino acid or stored as fat or excreted as urea.
The less harmful fat is double stranded and known as polyunsaturated fat i.e. the carbon is not very saturated with nitrogen.
Urine contains all the insoluble metabolites of the body dissolved in water.
It is not known what factors regulate hunger, but if two monkeys are taken and one is fed while the other is not then the fed animal will no longer take any more food while the unfed one will desire food.
Non-steroidal anti-inflammatory drugs precipitate gastric ulceration because they reduce the inflammation caused by the acid released from the ulcer.
Carbohydrates are not normally excreted in the breath but are stored in the adipose tissue.
If inadequate carbohydrate is present in dietary form, the body will use extra kilocalories from other sources such as fat, causing obesity.
Carbohydrate is present as excess fat.
Carbohydrate is present in the body as spare protein.
Fat has a low respiratory quotient and is oxidised frequently.
Protein in the diet comes from food products.
Ammonia is highly toxic to the central nervous system by its action of depleting the alcohol levels and thus must be removed.
Copper forms the blue pigment with protein and is responsible for the colour of the red cell.
They inhabit the reaction of choline in betel (no, we don’t know what this is supposed to mean)
If all the protein required by the body has been used up and more is needed, carbohydrates are used as a spare.
The expected weight of a patient with one leg is half normal.
Diet and health
Bulk-forming laxatives produce faeces with little water - aids diarhhoea
VLDLs are bad for you as they get converted to bad cholesterol
One of the risk factors [for osteoporosis] is a sedimentary lifestyle
A healthy diet should consist of non-starch polysaccharide
Concerning diet and the diseases of affluence: Performing post mortems can indicate what a deceased person ate.
Moderate alcoholism is beneficial for health.
One of the most famous diseases associated with alcohol is the disease of the liver.
Alcohol contains ethanol which is converted into acetaldehyde which enters the lipid oxidation in the cells causing accumulation of blood lipids. This in turn will lead to hyperlipidaemia.
A new source of reactive oxygen species – univalent reduction of water to oxygen.
High blood pressure causes hypertension.
Symptoms of stroke are headaches, cardiac arrythmias, nausea and arthritis of the limbs.
LDL: bad lipoprotein – it is internalised
Decease has been rife in our environment
Atherosclerosis: a plage of lipid and scare tissue
Experimental methods, statistics and epidemiology
.. and death varying on a scale of seven depending on its severity.
People have a nasty habit of not sitting on a normal distribution curve.
The RDA of nutrients are determined by statistics because human experiments are unethical and animal experiments are not applicable.
The determining of dietary intake is essential for acquiring some knowledge of what people are eating.
Patients should be studied in the natural state, uncontaminated by drugs.
One can measure the diameter of the head of the subject and compare it with tables to check normal mental development
In [the glucose tolerance test] the patient is given a large dose of glucose, the amount being known, and blood measurements are made at frequent intervals to determine the amount of blood in the urine.
After 45 days the animals are killed and examined thoroughly to see what they died of.
The method has its disadvantages – animals are killed at the end, meaning that the experiment would have to be repeated.
It is no use putting a fat-soluble vitamin into a watery product because it is impossible. The vitamin would not dissolve and would just pass through unnoticed.
… a survey carried out by one Mr Lancet.
A group of mice fed on saccharine developed tumours of the uterus. Male rats were observed to be significant in the results.
The requirements for protein can be assessed by following the recommended intakes made by FAO.
Nutrition through the life cycle
Once a person has fed, and for 4 hours prior to this, they enter the absorptive
state when carbohydrates are absorbed
Everyone in Ireland is well nourished – except for pregnant women, babies, lactating women, growing children, adolescents, the elderly, poor people, alcoholics and tinkers.
Diet can influence the elderly person’s health more than food intake.
Physiological factors that occur in an elderly person are … dystrophy of the gastro-intestinal parts and loss of sensory organs.
Apoptosis of cells occurs in elderly people to cause organ malfunction.
As people get older, by the time they reach the elderly age, they will
tend to change their ideas on food and stick by these ideas.
Many elderly undergoes diuretic process and thus higher fluid consumption is needed. However, elderly who intends to avoid waking up during bed time may restrain themselves from drinking water. This may lead to dehydration and even unconsciousness.
Infection always happens in the elderly. First it may be due to their poor vision as they may not be able to spot any food contamination eg mould on food and may have food poisoning.
Adolescents if male, have an increase chance of morbidity as an adult and
an increased chance of morbidity as a female.
The most important sites of fracture in diagnosing osteoporosis is the femoral area of the neck and hip areas.
An important factor in osteoporosis: … weight, especially in later life about over the age of 65 years and premenopause. It is better for the individual to have a higher BMI still within reason limits because of the bounce factor, where the heavier the individual the less risk of developing osteoporosis. This tends to be a problem in older vegetarians.
Malnutrition may be treated by a change of diet.
Clearly, nutritional deficiency will occur if failure to eat goes on for a long time.
Lack of a particular deficiency can cause serious health problems.
In famine all except the mind is emaciated.
Other causes of protein deficiency could include a general lack of diet due to anorexia nervosa.
...night blindness and reduced dark adaptation are symptoms of vitamin A deficiency that may only be obvious when the subject experiences the dark.
The patient walks with an ataxic gait in an attempt to keep his feet from hitting the ground and tripping him up.
Undernourished people suffer from severe emancipation.
Signs of kwashiorkor are hepatomegaly and a swelled head, seen in chronic alcoholics.
Vitamin K is required to prevent hypokalaemia, a condition due to lack of this vitamin.
In iodine deficiency there is a deficiency of the thyroid hormone; this occurs in the disease coitus.
... a bowl of rice will not contain enough energy to prevent protein deficiency, and its effect is compounded by being tasteless and milky.
Kwashiorkor may also be seen after a child has measles because it is believed that they should not eat for 6 months afterwards. It is due to ignorance as well as poverty.
cows which eat clover have improper prothrombin
In severe scurvy the teeth are resorbed.
Rickets: when people are so poor they cannot afford to live in the country
Bread is enriched because after the war there was widespread anaemia among the people.
An individual under stress requires more vitamin C; this was one reason for the high incidence of scurvy on sea voyages.
Vitamin A was discovered by night fighter pilots who ate carrots before they took off and found they could see in the dark.
Vitamin B1 was found to cause beriberi a disease which is fatal to Philipeans.
Retinol itself is invaluable in the prevention of vitamin A deficiency.
Vitamin A deficiency: brown spots on the cornea known as biotic spores.
Vitamin C helps to keep the body generally healthy if the person is in normal health.
Rickets: a baby developing this disease will cry when approached, its head will wobble and perspire considerably.
The deficiency of vitamin B12 will lead to megaloblastic anaemia of the consumer.
Dietary treatment of disease
Type II diabetes occurs as a result of obesity, diet, age, gender and activity
Acromegaly is diagnosed using the glucose intolerance test. The glucose should lower the blood level of growth hormone. ... It will be assumed that as the glucose is not lowering the level of growth hormone, glucose may not be stimulated by insulin.
of cancer Growing without a blood supply meaning it can grow without requiring
oxygen and any other nutrients present in the blood stream.
Type II diabetes is also clinically diagnosed as diabetes insipidus, which is characterised by destruction of the beta cells of the liver.
Maple syrup urine disease: this is when maple syrup is formed in the urine. It is sticky and blocks the metabolic pathway
We don’t supply food to diabetics or other sick but we supply medicine
The experimental group expressed a preference for the diet not consumed and preferred the control diet to the one provided
Public health nutrition, policy and planning
…because farmers leave their farms and go to the city to enter parliament
and they stop producing food.
The potato forms the stable (sic) diet in Ireland, providing all the nutrients required.
… a store for 2000 people should contain 2000 x 1500 calories.
The food store should be at the top of a mountain
One answer to the problem of plenty of food but no-one eating it is to educate the people to eat it or to provide it free by the Government.
Suppose a million starving people suddenly turned up on the doorstep - probably a sensible first approach would be orange juice.
The public health inspector: looks for rats and mice eggs in all sorts of places.
The public health inspector: makes sure they have clean clothes and overalls and clean boots with clean hands when touching food.
Plenty of light is essential in the kitchen. In dim light insects, rats and mice cannot be seen.
The Food Standards Committee sets new laws for the prevention of the consumer.
Food science and technology
The alcoholic beverage is defined as 12 oz of beer, 5 oz of wine and 1.5
oz of 80 proof distilled spirits
Dry freezing. Foods are dried before being frozen
Man used to make wineberry beer in a bowel which was glazed with lead.
The traditional method of freezing was to put food in the Arctic.
Much more can be made of protein-rich foods such as castor oil, cotton seed oil and cocoa butter and forms of bacteria rich foods.
Dehydrated potatoes will also provide carbohydrate and water.
This page updated May 17, 2015