Nutrition

Question 1

Pernicious anaemia (macrocytic + GI + neuro signs)
Weakness
Other AI conditions
Vegetarians / vegans

Answer 1

B12 - Cobalamin
(may be due to lack of intake in vegans + vegetarians, or parietal cell destruction in pernicious anaemia (no IF). Lack of B12 = cord degeneration
Ix: serum B12

Question 2

Deficiency = Dermatitis + anaemia
Excess = Neuropathy
Ix: RBC AST activation

Answer 2

B6 - Pyridoxine

Question 3

Fat soluble vitamins

Answer 3

ADEK

Question 4

Water soluble vitamins

Answer 4

B, C, folate

Question 5

Alcoholic
Tachycardia, dyspnoea, swelling (wet Beri-Beri)
Pain, tingling, paralysis (dry Beri-Beri)
Ataxia, confusion, eye involvement (Wernicke’s)
Ix: RBC transketolase

Answer 5

B1 - thiamine

Results in Beri-Beri (cardiogenic as well as neurological symptoms) as well as Wernicke’s (ACE)

Question 6

Bleeding gums
Ptechiae
Bone weakness

Answer 6

C - ascorbate (scurvy)

Question 7

Neural tube defect

Megaloblastic anaemia

Answer 7

Folate

Recommend 400ug up to 12w, 5mg if high risk

Question 8

Dementia, delirium, dermatitis (and death)

Answer 8

B3 - niacin (3Ds = pellagra)

Question 9

Beefy red tongue

Ix: RBC glutathionine

Answer 9

B2 - riboflavin (glossitis)
‘Two = tongue’
‘GluTWOthionine’

Question 10

Pabrinex

Answer 10

Vitamin B + C injection

Question 11

Wet Beri-Beri

Answer 11

Beri-Beri = B1 deficiency
Wet = cardiogenic (tachypnoea, dyspnoea, swollen ankles)

Question 12

Dry Beri-Beri

Answer 12

Beri-Beri = B1 deficiency
Dry = Neurogenic (pain, tingling, paralysis)

Question 13

Deficiency = Colour blindness
Excess = Exfolidation of skin, hepatitis

Answer 13

Vitamin A

Question 14

Deficiency = Rickets, osteomalacia
Excess = Hypercalcaemia

Answer 14

Vitamin D

Ix: Usually 25-OH-D3 (1,25 more specific but more ££)

Question 15

Defective clotting

Prolonged PTT

Answer 15

Vitamin K (II, VII, IX and X are vit K dependent)
Ix: PTT

Question 16

Haemolytic anaemia
Ataxia + areflexia
? Malignancy + IHD in later life

Answer 16

Vitamin E (tocopherol)

Question 17

Deficiency = Microcytic anaemia
Excess = Haemochromatosis

Answer 17

Iron

Question 18

Goitre, hypothyroidism

Answer 18

Iodine

Question 19

Deficiency = Dermatitis

Answer 19

Zinc

Question 20

Kaiser-Fleischer rings
Neuro signs
Low caeruloplasmin

Answer 20

Cu excess (Wilson’s)

Question 21

Deficiency = Dental caries
Excess = Tooth staining

Answer 21

Fluoride

Question 22

Lack of protein ONLY

Oedematous

Answer 22

Kwashiorkor

Question 23

Lack of ALL NUTRIENTS (proteins, carbs, fats)

Skeletal

Answer 23

Marasmus