Vitamins -Fahim

Question 1

You receive a report from the laboratory that a 1-year-old patient of yours who has experienced poor growth has an elevated sweat chloride level. The serum concentration of which of the following vitamins would you expect to be normal? 
A. A 
B. C 
C. D 
D. E 
E. K

Answer 1

B. C

CF problem with fat soluble vitamins (ADEK)

Question 2

What foods have a high Vitamin A content? What happens with Vitamin A deficiency?

Answer 2

carrots and veggies

deficiency: Night blindness, conjunctival xerosis, Bitot spots, keratomalacia (irreversible), worsens morbidity of the measles

Question 3

What is the most common cause of preventable blindness in children worldwide?

Answer 3

Vitamin A deficiency

Question 4

What are some symptoms of too much Vitamin A (vitamin A toxicity)?

Answer 4

Increased ICP (pseudotumor cerebri), dizziness, nausea, headaches, skin irritation, pain in joints and bones, coma, and even death

Question 5

What are some clinical manifestations of Vitamin E Deficiency?

Answer 5

Symptoms or “Eging” (like aging but with an E)

Myopathy
Ataxia
Pigmented retinopathy with vision loss
Loss of vibratory and position sense
Hyporeflexia
Generalized weakness
Hemolytic anemia

Question 6

How is Vitamin E deficiency measured?

Answer 6

< 5 mg/L serum alpha-tocopherol

Question 7

A 9-month-old African American boy comes in for his first visit. He has just moved from upstate New York, having received only sporadic well-care since his birth in September. He has been breastfed exclusively, and his length is at the 3rd percentile. Which of the following blood tests would you expect might yield an abnormal result? 
A. Alanine aminotransferase.
B. Alkaline phosphatase.
C. Blood urea nitrogen.
D. Glucose. 
E. Uric acid

Answer 7

B. Alkaline phosphatase.

Infants that are purely breast fed should supplement with vitamin D

expect high alk phos and low Ca2+ and phos.

Question 8

A 63 year old man who is an alcoholic is brought into the ED by his daughter. She states that the patient’s memory has been very poor and he constantly creates elaborate yet untrue stories. Physical examination reveals ataxia and bilateral horizontal nystagmus. Wernicke-Korsakoff syndrome, caused by water-soluble deficiency, is suspected. Which of the following conditions is also a result of a water soluble vitamin deficiency?
A. Increased erythrocyte hemolysis
B. Neonatal hemorrhage
C. Night blindness
D. Osteomalacia
E. Pellagra

Answer 8

E. Pellagra (vitamin B3 (niacin) deficiency)

Question 9

What causes A. Increased erythrocyte hemolysis?
B. Neonatal hemorrhage?
C. Night blindness?
D. Osteomalacia?

Answer 9

A=Vitamin E deficiency

B=Vitamin K deficiency

C=Vitamin A deficiency

D=Vitamin D deficiency

Question 10

A 17-year-old girl who comes to you as a new patient tells you that she has been eating a strict vegetarian diet for 5 years. You order a complete blood cell count because of concern about which of the following conditions?
A. Lymphocytosis.
B. Macrocytic anemia.
C. Microcytic anemia.
D. Normocytic anemia.
E. Thrombocytosis.

Answer 10

B. Macrocytic anemia.

B12 deficiency

Question 11

What can a vitamin B1 deficiency (thiamine) cause?

Answer 11

Wernickes

Beriberi

“Be the One Thai place that will give you Wet Berries”

Thiamine important in Ach synthesis

Question 12

What is Fahim’s crazy pneumonic for Vitamin B3 problems?

Answer 12

B 3D Nick

B3=niacin
Diarrhea, Dementia and Dermatitis from deficiency =”Pellagra”

Question 13

A 3 week old boy presents to his pediatrician because his mother has noticed that he “looks yellow.” On questioning, she elaborates that the jaundice began several days after birth and has been associated with dark urine and clay-colored stools. Laboratory studies show a direct bilirubin level of 5.0mg/dL and a total bilirubin level of 5.5mg/dL. Which of the following is characteristic of the most likely diagnosis?
A. Caused by a genetic mutation in a promoter region.
B. Caused by a deficiency in uridine 5’-diphosphoglucuronosyltransferase
C. Commonly treated with phototherapy
D. Inherited in an autosomal dominate pattern
E. Untreated it leads to cirrhosis by six months of age.

Answer 13

E. Untreated it leads to cirrhosis by six months of age.

pt has congenital extrahepatic biliary atresia

Question 14

When would you see breastfeeding jaundice? What is this due to?

Answer 14

Early onset (in 1st week of life)

due to: decreased caloric intake (milk is not in yet), mild dehydration, delayed passage of meconium

Question 15

When is Breast Milk Jaundice seen?

Answer 15

6th-14th day of life

Question 16

Vitamin B6 and B12 deficiencies will both give you ____ symptoms

Answer 16

neurological

Question 17

What deficiency is associated with microcytic anemia? Macrocytic?

Answer 17

B6- microcytic anemia*

B12= Macrocytic anemia

Question 18

What population is more likely to get vitamin B 12 deficiency?

Answer 18

vegans

B12 is only in animal products

Question 19

A 28 year-old previously healthy woman who is six months pregnant comes to the physician complaining of excessive fatigue for the past several months. Physical examination reveals pallor of her mucous membranes. A peripheral smear shows small RBCs containing a narrow rim of hemoglobin in the periphery. Which of the following laboratory values (Ferritin, Iron Binding Capacity and MCV) are most likely to be found in this patient?

Answer 19

Ferritin=low

Iron Binding capacity=high

MCV =low

Question 20

What is the most common nutritional deficiency in children?

Answer 20

Iron deficiency

can be caused by cows milk

microcytic hypochromatic anemia

Question 21

A 25 year old woman visits her primary care physician because of fatigue. Laboratory studies show:
WBC: 5000/mm Glucose: 98mg/dL
Hct: 28% Na: 139
Hb: 9.8 g/dL K: 4.3
MCV: 105fL Cl: 101
Platelets: 322 BUN: 15mg/dL
Cr: 0.9mg/dL
A schilling test is performed: A dose of radiolabeled B12 is administered orally and shortly thereafter a nonradiolabeled dose is given via injection. A 24 hour urine collection reveals no B12 excretion. One week later another dose of radiolabeled B 12 is administered along with intrinsic factor. This time B12 excretion in the urine is normal. The secretion of what substance is likely altered?
A. Bicarbonate
B. Gastrin
C. Hydrochloric acid
D. Insulin
E. Trypsin

Answer 21

C. Hydrochloric acid

pt has megaloblastic anemia secondary to pernicious anemia (MCV > 100 and hematocrit problem with intrinsic factor

IF produced by parietal cells
–> will also have problem with HCL because it is secreted by parietal cells

Question 22

Where is vitamin B6 found?

Answer 22

yeast, rice, polishing and cereals