Vitamin Deficiencies / Nutrition Flashcards
1
Q
What is Vitamin A responsible for?
A
- epithelial proliferation
- keratinisation and development
- Allows you to see???
2
Q
What are the main sources of Vitamin A?
A
(1) Animal (milk, liver, eggs, oily fish)
(2) Plant (green leafy veg, yellow/orange fruit)
3
Q
What are the clinical signs of Vitamin A deficiency?
A
Keratotic follicular papules on thighs/upper arms, dry skin
(1) = small bumps caused by a build-up of keratin on dry skin
(2) Vitamin A deficiency affects the production of visual pigments in the retina, leading to night blindness
(3) Bitot’s spots (the small white spots on the conjunctiva)
- a classic sign of deficiency
4
Q
How is Vitamin A deficiency diagnosed?
A
Serum vitamin A measurement
5
Q
What is the main function of Vitamin K?
A
Essential for blood coagulation factor activation
6
Q
What are the clinical features of Vitamin K deficiency?
A
(1) Bleeding tendency
(2) Purpura
(3) Easy bruising
7
Q
What investigations confirm Vitamin K deficiency?
A
Coagulation tests & serum Vitamin K
8
Q
What is Vitamin B2 (riboflavin) essential for?
A
co-factor in numerous metabolic reactions
9
Q
What are the main dietary sources of Vitamin B2?
A
Milk, liver, meat, eggs, leafy green vegetables
10
Q
What are the signs of Vitamin B2 deficiency?
A
(1) Cheilosis
= Cracks or sores at the corners of the mouth
(2) Angular stomatitis
= inflammation/sores at end of mouth
(3) Painful red dry tongue
11
Q
What test is used to diagnose Vitamin B2 deficiency?
A
Erythrocyte glutathione reductase activity
12
Q
What is the classic syndrome caused by Vitamin B3 deficiency (Niacin) ?
A
Pellagra – marked by the ‘Four Ds’
13
Q
What are the ‘Four Ds’ of Pellagra?
A
- Dermatitis
- Delirium
- Diarrhoea
- Death
14
Q
What dietary sources provide Vitamin B3?
A
Meat, fish, nuts, coffee; also synthesised from tryptophan
15
Q
How is Vitamin B3 deficiency diagnosed?
A
Clinical diagnosis
= niacin levels difficult to measure
16
Q
What are common sources of Vitamin B6?
A
Meat, cereals, milk, potatoes, bananas, nuts, pulses
17
Q
What are the clinical signs of Vitamin B6 deficiency?
A
Dermatitis
(face, scalp, neck, shoulders, perineum)
Glossitis
= inflammation of the tongue
18
Q
How is Vitamin B6 deficiency diagnosed?
A
Serum or urinary Vitamin B6 levels
19
Q
What is the main function of Biotin?
A
Essential co-factor for carboxylase enzymes
20
Q
What are the sources of Biotin?
A
Cereals, milk, meat, eggs, pulses, nuts; also produced by gut bacteria
= drinking raw eggs
21
Q
What are the signs of Biotin deficiency?
A
- Facial dermatitis
- Glossitis
- Alopecia (rare)
22
Q
How is Biotin deficiency diagnosed?
A
Serum biotin measurement
23
Q
What is Vitamin C essential for?
A
- Collagen formation
- Bone & teeth health
- Wound healing
24
Q
What are the symptoms of Vitamin C deficiency (Scurvy)?
A
- Hyperkeratosis around hair follicles
- Bent hairs
- Inflamed gums
- Poor wound healing
- Fatigue
- Muscle pain
25
What are the clinical features of Vitamin C deficiency?
(1) spontaneous bleeding and bruising
(2) gingival swelling
(3) coiled hairs
(4) teeth loss
26
What are the dietary sources of Zinc?
Meat, fish, milk, eggs, cereals, nuts, pulses
27
What is acrodermatitis enteropathica?
Genetic disorder causing insufficient zinc absorption
1. leading to diarrhoea
2. alopecia
3. brittle hair
4. perioral
5. acral dermatitis
28
What are the clinical signs of acquired Zinc deficiency?
1. Dermatotic rash (hands/feet)
2. Growth retardation in children
29
What disease is a result of niacin deficiency?
Pellagra
30
A 25-year-old male patient presents to the general practitioner with fatigue, easy bruising, and tooth loss. He admits to having no fixed abode and is a refugee, having recently arrived from Afghanistan.
On physical examination there are multiple ecchymoses at non-traumatic sites, perifollicular haemorrhages, coiled hairs, and gingival swelling.
Given the most likely diagnosis, how should this patient be managed?
Vitamin C replacement
31
A 62-year-old man from Egypt presents with increasing forgetfulness. He has also noticed that his stools have been loose. On examination, you see some pigmentation of the skin around the neck.
What is the most appropriate next step?
Nicotinamide (Vitamin B3)
32
A 32-year-old woman with severe obsessive compulsive disorder complains of bleeding gums and feeling tired all the time. She has a severely restricted diet. On examination she has pale conjunctivae, multiple ecchymoses on her arms and her gingiva are soft, swollen and bleed easily. Her eyes have a bulging appearance.
What investigation should be ordered to confirm the most likely diagnosis?
Serum vitamin C
33
A 42-year-old man from Sierra Leone presents to the emergency department with worsening non-bloody diarrhoea. His wife reports that he has become more confused over the last few days. He has a significant history of tuberculosis and takes isoniazid only. On examination, there is erythema and thickening of the skin on the hands, feet and neck.
What is the most likely diagnosis?
Pellagra-like syndrome
= Vitamin B3/Niacin Deficiency
34
A 23-year-old woman with anorexia nervosa presents to the general practitioner with a one-month history of diarrhoea. On further questioning, she reports having a pigmented scaly rash on the back of her hands and neck. She reveals that she has been feeling low for the past few weeks.
What is the most likely underlying cause of her presentation?
Vitamin B3 deficiency
35
A 4-year-old child from a low-income family presents with difficulty seeing in low light, dry and rough skin, and small white spots on the conjunctiva.
What condition is the most likely cause of the child's symptoms?
Vitamin A deficiency
36
A 39-year-old man presents to his GP complaining his skin has been more itchy and dry recently. He has also had intermittent episodes of diarrhoea, and feels like he is more anxious and forgetful than normal. On examination you notice erythematous plaques with excoriations on his forearms and hands, neck, and face. His medical history includes alcoholic fatty liver disease, he is a non-smoker, and drinks over 30 units daily.
Which vitamin deficiency is the most likely cause of his symptoms?
Vitamin B3
37
A 59-year-old unkempt woman presents to the GP because she worries about how easily she is bruising. On discussion, you find out she is at risk of self-neglect, and for the past two months she has lived off a diet of tea and toast. On examination she has bleeding, soft gums, and widespread ecchymosis. Last month she fractured her forearm following a fall, and she has a small partially opened wound on her arm from this same event.
Which vitamin is this patient deficient in?
Vitamin C
38
A 43-year-old man presented with loose stools. He was unable to give an accurate description of the onset and duration of his symptoms. He had a history of alcohol excess.
On examination, he had erythematous scaly patches on sun-exposed areas.
Which condition is the most likely cause of his presentation? Explain your answer
Niacin deficiency - vitamin B3
= deficiency leads to pellagra
= characterised by the
'three D's'
1. Diarrhoea
2. Dermatitis (photosensitive rash)
3. Dementia (cognitive impairment)
39
A 28-year-old woman visits her GP complaining of fatigue, weakness, and easy bruising over the past three months. She mentions that she has a poor diet that primarily consists of processed foods, with a minimal intake of fruits and vegetables. The GP suspects a deficiency in a specific nutrient that acts as a cofactor for enzymes involved in producing proline and lysine.
What nutrient is most likely to be deficient in this patient?
Vitamin C
= Ascorbic acid is a cofactor for enzymes used in the production of proline and lysine
40
A 70-year-old woman presents to her general practitioner with complaints of lethargy, fatigue, anorexia, and gingival bleeding. On examination, multiple bruise marks and scattered petechiae are noted on the upper and lower limbs. There is also the presence of perifollicular haemorrhage and purpura on both legs
What is this woman deficient in?
vitamin C
41
A mother brings her 16-year-old daughter to the general practice. Over the last month, she has been experiencing epistaxis, lethargy and mouth ulcers. As well as this, she has noticed small amounts of blood mixed in with the toothpaste after brushing. The mother explains how her daughter has struggled with anorexia in the past and that she is very selective about the foods she eats.
On examination, there is conjunctival pallor and her gingiva are inflamed.
Lack of production in which protein(s) is caused by this patient's vitamin deficiency?
Proline and lysine
42
A patient with megaloblastic, macrocytic anaemia caused by folate deficiency. He is also tested for Vitamin B12 deficiency before he is started on treatment.
How are these two vitamins related?
Vitamin B12 regenerates folic acid in the body
43
A 46-year-old man presents to his GP due to haemoptysis. He notes that he wakes up due to severe sweating, and he has lost considerable weight in the last few weeks. He returned from a holiday in Pakistan just over a month ago. PCR on a sputum confirms the suspected diagnosis of tuberculosis. He is started on 4 different antibiotics and is prescribed pyridoxine, as one of these antibiotics causes vitamin B6 deficiency
Which antibiotic is responsible for this side effect?
Isoniazid causes vitamin B6 deficiency
44
A 40-year-old vegan mother presents to the clinic. She has recently conceived a child and is seeking dietary advice. She wants her child to be as healthy as possible, but will not have any animal-based products.
What is the most appropriate advice to give her?
Vitamin B12 will need to be supplemented to ensure adequate levels as the only source of vitamin B12 for humans is animal-based foods
45
A 5-year-old boy is brought to the GP clinic by his mother, concerned because he has developed sore, red and scabbed areas at the corners of his mouth which have been present for 6 weeks. He is otherwise well with normal skin, teeth and gums. He has a background of autistic spectrum disorder and his mother describes that he only tolerates a small variety of foods in his diet.
What vitamin deficiency is most likely responsible for the symptoms?
B2
= Riboflavin deficiency causes angular cheilitis
46
Vitamin B6 (pyridoxine) features
1. seizures
2. peripheral neuropathy
3. sideroblastic anaemia
47
Vitamin B7 (biotin) features
1. alopecia
2. dermatitis
48
Vitamin B1 (thiamine) features
1. muscle weakness
2. anergia
3. caused by alcohol excess maybe
4. peripheral neuropathy
49
An 8-year-old girl with coeliac disease presents to her GP with a 1-month history of easy bruising and recurrent nosebleeds. You remember that coeliac disease can result in vitamin K malabsorption, and request a clotting screen.
What clotting factor would be the first to drop in concentration?
7
= shortest half life
50
A 43-year-old woman presents with lethargy, bony pain, and proximal muscle weakness. She has no underlying co-morbidities. Blood tests are consistent with osteomalacia and you prescribe vitamin D supplementation.
What is the primary mechanism by which this treatment increases serum calcium?
Increased absorption of calcium via the small intestine
converted via kidneys
51
A patient from East Asia starts showing signs of distal peripheral polyneuropathy, exhibiting paraesthesia and reduced knee jerks due to a chronic deficiency of a vitamin. A specific diphosphate form of this vitamin acts as a co-factor for the pyruvate dehydrogenase complex during the conversion of pyruvate into acetyl-CoA.
What vitamin is this patient deficient in?
B1
52
A 6-year-old male presents to the GP with his mother. They have recently immigrated from Asia to the UK. He has been experiencing pain and tenderness in both legs, this has progressively become worse over the last year. His mother is concerned as he has been showing reluctance to walk and weight bear on his legs. On examination, there is marked bowing and tenderness of both tibia. What vitamin is he likely to be deficient in?
D
= boy has rickets
53
An 88-year-old woman is admitted via the emergency department following a fall and is assessed as suffering from self-neglect. She complains of a 3-month history of fatigue, paraesthesia in her lower limbs and generalised muscle weakness that is worse in her legs. She has been struggling to continue with her activities of daily living, particularly cooking, as she cannot stand for extended periods.
Which of the following vitamins is she most likely to be deficient in?
Vitamin B12
54
A 32 year old lady with no underlying co-morbidities presents as she has found she is pregnant. You counsel her about pregnancy supplements. She asks if she can just continue her usual multivitamin tablet she buys over the counter. Which vitamin, if taken in high doses, can be teratogenic?
A
