Vitamins & Minerals

Question 1

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

Answer 1

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

Toxicity: Pseudotumor cerebri, bone thickening, teratogenic

Question 2

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

Answer 2

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

Toxicity: n/a

Question 3

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

Answer 3

Deficiency: Rickets, osteomalacia, hypocalcemia

Toxicity: Hypercalcemia, nausea, renal toxicity

Question 4

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

Answer 4

Deficiency: Anemia, peripheral neuropathy, ataxia

Toxicity: Necrotizing enterocolitis (infants)

Question 5

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

Answer 5

Deficiency: Hemorrhage, prolonged prothrombin time

Toxicity: Hemolysis (kernicterus)

Question 6

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

Answer 6

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

Toxicity: n/a

Question 7

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

Answer 7

Deficiency: Angular stomatitis, dermatitis

Toxicity: n/a

Question 8

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

Answer 8

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

Toxicity: n/a

Question 9

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

Answer 9

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

Toxicity: Peripheral neuropathy (only B vitamin with toxicity)

Question 10

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

Answer 10

Deficiency: Megaloblastic anemia plus neurologic symptoms

Toxicity: n/a

Question 11

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

Answer 11

Deficiency: Megaloblastic anemia without neurologic symptoms

Toxicity: n/a

Question 12

Specify the signs and symptoms of Iron deficiencies and toxicities.

Answer 12

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

Toxicity: Hemochromatosis

Question 13

Specify the signs and symptoms of Iodine deficiencies and toxicities.

Answer 13

Deficiency: Goiter, cretinism, hypothyroidism

Toxicity: Myxedema

Question 14

Specify the signs and symptoms of Fluoride deficiencies and toxicities.

Answer 14

Deficiency: Dental caries (cavities)

Toxicity: Fluorosis with mottling of teeth and bone exostoses

Question 15

Specify the signs and symptoms of Zinc deficiencies and toxicities.

Answer 15

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

Toxicity: n/a

Question 16

Specify the signs and symptoms of Copper deficiencies and toxicities.

Answer 16

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

Toxicity: Wilson’s disease

Question 17

Specify the signs and symptoms of Selenium deficiencies and toxicities.

Answer 17

Deficiency: Cardiomyopathy and muscle pain

Toxicity: Loss of hair and nails

Question 18

Specify the signs and symptoms of Manganese deficiencies and toxicities.

Answer 18

Deficiency: n/a

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

Question 19

Specify the signs and symptoms of Chromium deficiencies and toxicities.

Answer 19

Deficiency: Impaired glucose tolerance

Toxicity: n/a

Question 20

What are the fat-soluble vitamins?

In what general category of patients are they deficient?

Answer 20

Vitamins ADEK

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

Question 21

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

Answer 21

folate, thiamine, phosphorus, and magnesium

Question 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?

Answer 22

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.

Question 23

What is the classic iatrogenic cause of vitamin B6 deficiency?

Answer 23

Prolonged therapy with isoniazid (especially in young people).

Question 24

Which 3 medications may cause folate deficiency?

Answer 24

Anticonvulsants (especially phenytoin)

methotrexate

trimethoprim

Question 25

Which vitamin is a known teratogen? What are the restrictions regarding its use?

Answer 25

**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.

Question 26

Which vitamin should be taken by all sexually active women of reproductive age? When should she take it for maximal benefit?

Answer 26

Folate, which reduces the risk of neural tube defects in the fetus. The maximal benefit occurs **before** the woman knows that she is pregnant.

Question 27

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

Answer 27

* 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

Question 28

Which vitamin is given to all newborns?

Answer 28

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

Question 29

Which clotting factors are affected by vitamin K? What happens in the setting of severe liver disease and how should it be managed?

Answer 29

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.

Question 30

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

Answer 30

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.

Question 31

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

Answer 31

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