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Flashcards in Vitamins & Minerals Deck (31):
1

Specify the signs and symptoms of Vitamin A deficiencies and toxicities.

Deficiency: Night blindness, scaly rash, xerophthalmia (dry eyes), Bitot spots (debris on conjunctiva); increased infections

Toxicity: Pseudotumor cerebri, bone thickening, teratogenic

2

Specify the signs and symptoms of Vitamin C deficiencies and toxicities.

Deficiency: Scurvy (hemorrhages/skin petechiae, bone, gums; loose teeth; gingivitis), poor wound healing, hyperkeratotic hair follicles, bone pain (from periosteal hemorrhages)

Toxicity: n/a

3

Specify the signs and symptoms of Vitamin D deficiencies and toxicities.

Deficiency: Rickets, osteomalacia, hypocalcemia

Toxicity: Hypercalcemia, nausea, renal toxicity

4

Specify the signs and symptoms of Vitamin E deficiencies and toxicities.

Deficiency: Anemia, peripheral neuropathy, ataxia

Toxicity: Necrotizing enterocolitis (infants)

5

Specify the signs and symptoms of Vitamin K deficiencies and toxicities.

Deficiency: Hemorrhage, prolonged prothrombin time

Toxicity: Hemolysis (kernicterus)

6

Specify the signs and symptoms of Vitamin B1 deficiencies and toxicities.

Deficiency: Wet beriberi (high-output cardiac failure), dry beriberi, (peripheral neuropathy), Wernicke and Korsakoff syndromes

Toxicity: n/a

7

Specify the signs and symptoms of Vitamin B2 (riboflavin) deficiencies and toxicities.

Deficiency: Angular stomatitis, dermatitis

Toxicity: n/a

8

Specify the signs and symptoms of Vitamin B3 (niacin) deficiencies and toxicities.

Deficiency: Pellagra (dementia, dermatitis, diarrhea), stomatitis

Toxicity: n/a

9

Specify the signs and symptoms of Vitamin B6 (pyridoxine) deficiencies and toxicities.

Deficiency: Peripheral neuropathy, stomatitis, convulsions in infants, microcytic anemia, seborrheic dermatitis

Toxicity: Peripheral neuropathy (only B vitamin with toxicity)

10

Specify the signs and symptoms of Vitamin B12 (cobalamin) deficiencies and toxicities.

Deficiency: Megaloblastic anemia plus neurologic symptoms

Toxicity: n/a

11

Specify the signs and symptoms of Folic acid deficiencies and toxicities.

Deficiency: Megaloblastic anemia without neurologic symptoms

Toxicity: n/a

12

Specify the signs and symptoms of Iron deficiencies and toxicities.

Deficiency: Microcytic anemia, koilonychia (spoon- shaped fingernails)

Toxicity: Hemochromatosis

13

Specify the signs and symptoms of Iodine deficiencies and toxicities.

Deficiency: Goiter, cretinism, hypothyroidism

Toxicity: Myxedema

14

Specify the signs and symptoms of Fluoride deficiencies and toxicities.

Deficiency: Dental caries (cavities) 

Toxicity: Fluorosis with mottling of teeth and bone exostoses

15

Specify the signs and symptoms of Zinc deficiencies and toxicities.

Deficiency: Hypogeusia (decreased taste), rash, slow wound healing

Toxicity: n/a

16

Specify the signs and symptoms of Copper deficiencies and toxicities.

Deficiency: Menkes syndrome (X-linked; kinky hair, mental retardation) 

Toxicity: Wilson's disease

17

Specify the signs and symptoms of Selenium deficiencies and toxicities.

Deficiency: Cardiomyopathy and muscle pain

Toxicity: Loss of hair and nails

18

Specify the signs and symptoms of Manganese deficiencies and toxicities.

Deficiency: n/a

Toxicity: “Manganese madness” in miners of ore (behavioral changes/psychosis)

19

Specify the signs and symptoms of Chromium deficiencies and toxicities.

Deficiency: Impaired glucose tolerance

Toxicity: n/a

20

What are the fat-soluble vitamins?

In what general category of patients are they deficient?

Vitamins ADEK 

Deficiency may be a result of malabsorption (cystic fibrosis, cirrhosis, celiac disease, duodenal bypass, bile-duct obstruction, pancreatic insufficiency, chronic giardiasis).

21

What vitamin, mineral, and electrolyte deficiencies are classically seen in alcoholics?

folate, thiamine, phosphorus, and magnesium

22

What is the most common cause of vitamin B12 deficiency?

What are 3 conditions associated with pernicious anemia?

What are exotic causes of B12 deficiency?

How do you diagnose it?

Pernicious anemia - antiparietal cell antibodies destroy the ability to secrete intrinsic factor, and acid

Conditions associated with pernicious anemia: hypothyroidism, type 1 diabetes, and vitiligo.

Exotic causes: tapeworm Diphyllobothrium latum, removal of the ileum

Diagnosis: low serum B12 level,  (+) anti-intrinsic factor antibodies is highly confirmatory for pernicious anemia. The Schilling test is of historical interest but is no longer commonly employed in the diagnosis of B12 deficiency.

23

What is the classic iatrogenic cause of vitamin B6 deficiency?

Prolonged therapy with isoniazid (especially in young people). 

24

Which 3 medications may cause folate deficiency?

Anticonvulsants (especially phenytoin)

methotrexate

trimethoprim

25

Which vitamin is a known teratogen?

What are the restrictions regarding its use?

Vitamin A

Female patients taking vitamin A or a derivative (Isotretinoin) must have a negative pregnancy test before the medication is started and should be counseled about the risks of fetal teratogenicity. There are strict qualification criteria, including monthly pregnancy testing, and two forms of contraception are recommended.

26

Which vitamin should be taken by all sexually active women of reproductive age?

When should she take it for maximal benefit?

Folate, which reduces the risk of neural tube defects in the fetus.

The maximal benefit occurs before the woman knows that she is pregnant.

27

What are the physical findings of rickets (vitamin D deficiency in children)?

  • Craniotabes (poorly mineralized skull; bones feel like a ping-pong ball)
  • Rachitic rosary (costochondral beading; small round masses on anterior rib cage)
  • Delayed fontanelle closure
  • Bossing of the skull
  • Kyphoscoliosis
  • Bow-legs and knock-knees
  • Bone changes appear first at the lower ends of the radius and ulna

28

Which vitamin is given to all newborns?

Vitamin K is given as prophylaxis against hemorrhagic disease of the newborn.

29

Which clotting factors are affected by vitamin K?

What happens in the setting of severe liver disease and how should it be managed?

Vitamin K is needed for hepatic synthesis of factors II, VII, IX, X, proteins C/S.

Chronic liver disease (cirrhosis) can cause prolongation of PT/INR because of the liver's inability to synthesize clotting factors even in the presence of adequate vitamin K levels.

This problem should be corrected with fresh frozen plasma; vitamin K is ineffective in the setting of severe liver disease.

30

Describe the relationship between vitamin K and broad-spectrum antibiotics.

Prolonged therapy with broad-spectrum antibiotics is a potential cause of vitamin K deficiency, as these medications can eliminate the normal gut bacteria that synthesize much of the vitamin K required daily.

31

What is the classic Step 2 description of a vitamin C–deficient patient?

An older adult with a diet of “hot dogs and soda” or “tea and toast” whose symptoms include bleeding gums and bone pain.