Nutritional Abnormalities

Question 1

Vitamins that must be measured as derivatives/metabolites

Answer 1

B6 (pyridoxial 5 phosphate)

B12 (serum test is available, but can also test for MMA or homocysteine)

Question 2

Vitamins than cannot be directly measured

Answer 2

Calcium, sodium, vitamin K

Question 3

Elements of Thiamine (B1 deficiency)

Answer 3

Dry Beriberi
Wet Beriberi (w/CHF)
Wernicke’s encephalopathy
Korsakoff psychosis

Question 4

Elements of Beriberi (thiamine deficiency)

Answer 4

Peripheral neuropahty
wrist/foot drop (also seen in lead poisoning)
Ataxia (also seen in lead poisoning)
angular stomatitis
CHF in wet only

Question 5

Vitamin deficiency that results in hyperseg neutrophils

Answer 5

Folate

Question 6

Vitamin deficiency with decreased vibratory and position sense

Answer 6

B12

Question 7

Vitamin deficiency associated with hyperkeratosis and artrhralgia

Answer 7

Vitamin C

Question 8

Vitamin deficiency associated with follicular hyperplasia

Answer 8

Vitamin C OR Vitamin A (B-cell hyperplasia

Question 9

Vitamin deficiency associated with nystagmus and opthalmoplegia

Answer 9

B12

Question 10

Symptoms of folate Vitamin deficiency

Answer 10

Macrocytic hypochromic anemia
Hypersegmented neutrophils
sore tongue
diarrhea
depression
neural tube defects in fetus

Question 11

Symptoms of B12 Vitamin deficiency

Answer 11

Opthalmoplegia
Nystagmus
Macrocytic anemia
Demyelination
Dementia
Loss of positional and vibrational senses
Cheilosis

Question 12

Vitamin deficiency associated with muscle weakness

Answer 12

potassium, vitamin D

Question 13

Vitamin deficiencies associated with dementia

Answer 13

Thiamine (wernicke’s)
Niacin (3 D’s)
B12 (demyelination)

Question 14

Wernicke’s Encephalopathy features

Answer 14

Mental status changes
Delirium
Nystagmus or opthalmoplegia
axaxia or tremor

Korsakoff is a progression to confabulation

Question 15

Vitamin deficiency associated with muscle spasms/tetany

Answer 15

Calcium, magnesium

Question 16

Vitamins deficient in a vegan diet

Answer 16

B12, zinc, calcium, vitamin D

Question 17

Vitamins deficient in an alcoholic diet

Answer 17

B1, B6, B12, folate, C

Question 18

Vitamins commonly deficient in elderly

Answer 18

Vitamin C and folate (no fresh foods)
Zinc (eat lots of grains and little meat)
Vitamin D (little sun exposure)

Question 19

Causes of secondary losses of magnesium

Answer 19

Diarrhea
Diuretics
Diabetes (urinary losses)
Alcoholics

Question 20

Vitamin deficiency in gastric bypass

Answer 20

Bypasses the stomach and duodenum
B12
Iron
Calcium
ADEK (duodenum has pancreatic enzymes, same reason ADEK is low in celiac)

Question 21

Vitamins deficient in blind loop syndrome

Answer 21

B12 and ADEK

Question 22

Vitamins deficient in smokers due to altered metabolism

Answer 22

C, E, folate

Question 23

Vitamins deficient due to altered metabolism in cancer patients

Answer 23

A, C, folate, thiamin, iron, zinc

Question 24

Vitamins deficient in patients with liver disease

Answer 24

Iron, K, copper, selenium, magnesium, zinc, potassium

Question 25

Vitamin deficiency with steroid use

Answer 25

Vitamin D, calcium

Question 26

Vitamin deficiency with phenytoin use

Answer 26

D, calcium, folate

Question 27

Vitamin deficiency with use of sulfasalazine, TMP-sulfa, methotrexate

Answer 27

Folate

Question 28

Vitamin deficiency with INH use

Answer 28

B6

Question 29

Vitamin deficiency with PPI use

Answer 29

B12
Divalent cations (calcium, magnesium)
Iron (acid keeps it ferric)