Rubin's Chapter 8 Flashcards
47 yo M, 6 week history of increase fatigue and dark colored stools. CBC shows hemoglobin 8.6 g/L and microcytic, hypochromic RBCs. Upper GI endoscopy: peptic ulcer. What deficiency is causing this anemia?
Iron. GI hemorrhage leads to loss of heme iron at a rate faster than it is replaced from dietary sources, leading to microcytic hypochromic anemia.
49 y F, 2 mo ho yellow discoloration of eyes, abdominal pain, weight loss, low fever. Physical: distended abdomen, RUQ tenderness, palpable liver. Liver biopsy: alcoholic hepatitis. She is advised to stop drinking alcohol and then instead she drinks antifreeze (ethylene) this leads to failure of which organ?
Kidney - major toxicity of ethylne glycol is acute necosis of the kidney, which leads to renal failure.
A 15-year-old African boy has a history of tooth loss, gingivitis, skin hemorrhages, multiple infections, and poor wound healing. Physical examination shows that the child is in the 20th percentile for height and 10th percentile for weight. This patient
most likely has which condition?
Scurvy. Vitamin C is essential for collagen synthesis and its deficiency results in poor wound healing and easy damage with mild trauma.
24 yo F eats only corn based foods. She presents w/ dermatitis, diarhea and dementia. What does she have?
Pellagra, niacin/tryptophan deficiency.
Homeless man, chronic alcohol, brought to ED in wasted state. He has peripheral neuropathy, trouble balancing and dementia. He dies suddenly of an arrhythmia and at autopsy, lesions are found in the mamillary bodies around the 3rd ventricle. Which vitamin deficiency?
B1, thiamine. This man suffers
from beri-beri (heart) and Wernicke-Korsakoff syndrome
(brain). Thiamine defi ciency in deteriorated alcoholics results
in encephalopathy, peripheral neuropathy, and other disorders. Atrophy of the mammillary bodies, with loss of ganglion cells and rupture of small blood vessels, is characteristic.
45 to F, chronic Crohn disease and severe fat malabsorption. Fracture of femoral neck after minor contusion. Which vitamin deficiency?
Vitamin D. Lipid malabsorption interferes with vitamin D absorption resulting in a deficiency. In adults, vitamin D deficiency causes osteomalacia - inadequate mineralization of new bone matrix – weak bones, vulnerable to fracture.
50 yo F presents w/ easy fatigability, smooth sore tongue, numbness and tingling of the feet and weakness of the legs. CBC shows megablastic anemia that is not reversed w/ folate therapy.
Vitamin B12 - megaloblastic anemia.
Starving 4 year old african boy presents with apathy, generalized edema and enlarged, fatty liver. Despite growth failure, subcutaneous fat is preserved. What does he have?
Kwashikor. Lack of protein in diet but high carb – edema, enough subcutaneous fat, fatty liver.
Petechial hemorrhages were noticed on the upper and lower extremeties of a 5 day old infant. Hemorrhagic disease of the neonate was caused by deficiency of which vitamin?
Vitamin K. Hemorrhagic disease of the neonate may be caused by vitamin K deficiency, due to its role as a coagulation cofactor.
6 year old African girl: wasting of muscle and fat, as well as a protuberant abdomen. Her pulse, blood pressure and temperature are low. Her face is wrinkled. No generalized edema.
Marasmus – total starvation, deficiency of all dietary elements. Decreased fat, protruding belly, muscle loss and wrinkled face. Organ wasting and increased lipofuscin pigment. No edema
40 y M from Vietnam, chronically ill - presents w/ painful sores around mouth. Cheilosis - prominent sores at corners of the mouth. Which vitamin deficiency?
Riboflavin, B2. Seborrheic keratosis and interstitial keratitis of the cornea also occur in patients with vitamin B
2(riboflavin) deficiency.
32 yo vegan. Weak, pale and labs show macrocytic, normochromic anemia. Which vitamin deficiency?
Vitamin B12. Found only in animal products, deficiency causes macrocytic anemia.
16 yo girl w/ celiac disease reports steatorrhea. She suddenly develops RLQ abdominal pain. A complete CBC shows hemoglobin level 14 g/dL, WBC 18,000/uL with 84% neutrophils. She goes into surgery for appendicitis and has prolonged prothombin time. What is the cause of her coagulation problem?
Vitamin K deficiency.
