Vitamins

Question 1

Vitamin B1 (thiamine) deficiency

Answer 1

Wernicke-Korsakoff syndrome and beriberi.

Question 2

polyneuritis, symmetrical muscle wasting.

Answer 2

Dry beriberi; thiamine deficiency

Question 3

high-output cardiac failure (dilated cardiomyopathy), edema.

Answer 3

Wet beriberi; thiamine deficiency

Question 4

confusion, ophthalmoplegia, ataxia + confabulation, personality change, memory loss (permanent); dx/ damage where?

Answer 4

Wernicke-Korsakoff syndrome; Damage to medial dorsal nucleus of thalamus, mammillary bodies.

Question 5

Vitamin A deficiency

Answer 5

Night blindness (nyctalopia); hypoparathyroidism; dry, scaly skin (xerosis cutis); alopecia; corneal degeneration (keratomalacia); immune suppression.

Question 6

Vitamin A toxicity

Answer 6

Arthralgias, skin changes (scaliness), alopecia, cerebral edema, pseudotumor cerebri, hyperparathyroidism, osteoporosis, hepatic abnormalities. Teratogenic (cleft palate, cardiac abnormalities)

Question 7

Vitamin B2 deficiency

Answer 7

Cheilosis (inflammation of lips, scaling and fissures at the corners of the mouth), Corneal vascularization, Stomatitis, Glossitis, normocytic Anemia, seborrheic dermatitis

Question 8

Vitamin B3 Niacin deficiency

Answer 8

Glossitis. Severe deficiency leads to pellagra w/ Diarrhea, Dementia, Dermatitis, Death

Question 9

Diarrhea, Dementia (also hallucinations), Dermatitis (Casal necklace or hyperpigmentation of sun-exposed limbs). Dx? Etiologies?

Answer 9

Pellagra: severe vitamin B2 deficiency, Hartnup disease (decreased tryptophan absorption), malignant carcinoid syndrome (increased tryptophan metabolism), and isoniazid (decreased vitamin B6).

Question 10

Vitamin B5 Pantothenate deficiency

Answer 10

Burning feet syndrome, Dermatitis, enteritis, alopecia, adrenal insufficiency.

Question 11

Vitamin B6 Pyridoxine deficiency

Answer 11

Convulsions, hyperirritability, Peripheral neuropathy (via isoniazid, oral contraceptives), sideroblastic anemias due to impaired hemoglobin synthesis and iron excess.

Question 12

Vitamin B9 (folic acid) deficiency sx?

Answer 12

Macrocytic, megaloblastic anemia; hypersegmented polymorphonuclear cells (PMNs); glossitis; no neurologic symptoms (as opposed to vitamin B12 deficiency)

Question 13

Vitamin B9 (folic acid) deficiency labs? Drugs inducing?

Answer 13

Increased Homocysteine, NORMAL methylmalonic acid; worst w/ phenytoin, sulfonamides, methotrexate

Question 14

Vitamin B12 (cobalamin) deficiency sx?

Answer 14

Macrocytic, megaloblastic anemia; hypersegmented PMNs; paresthesias, and subacute combined degeneration (degeneration of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts) due to abnormal myelin.

Question 15

Vitamin B12 (cobalamin) deficiency labs?

Answer 15

Increased serum homocysteine AND methylmalonic acid levels. Prolonged deficiency leads to irreversible nerve damage.

Question 16

Vitamin B12 (cobalamin) deficiency etiology?

Answer 16

Veganism, malabsorption (e.g., sprue, enteritis, Diphyllobothrium latum), lack of intrinsic factor (pernicious anemia, gastric bypass surgery), or absence of terminal ileum (Crohn disease). Anti-intrinsic factor antibodies diagnostic for pernicious anemia.

Question 17

Vitamin C (ascorbic acid) deficiency?

Answer 17

Scurvy: bleeding swollen gums, petechiae, bruising, hemarthrosis, anemia (Fe absorption), poor wound healing (collagen defect), perifollicular and subperiosteal hemorrhages, “corkscrew” hair. Weakened immune response.

Question 18

Vitamin D deficiency?

Answer 18

Rickets in children (bone pain and deformity), osteomalacia in adults (bone pain and muscle weakness), hypocalcemic tetany

Question 19

Vitamin D toxicity?

Answer 19

Hypercalcemia, polydipsia, polyuria, hypercalciuria, loss of appetite, stupor. Sarcoidosis (increased activation of vitamin D by epithelioid macrophages).

Question 20

Vitamin E (tocopherol/tocotrienol) deficiency?

Answer 20

Hemolytic anemia, acanthocytosis, muscle weakness, posterior column and spinocerebellar tract demyelination (similar to B12 def w/o hypersegmented PMNs)

Question 21

Vitamin K deficiency?

Answer 21

Neonatal hemorrhage with increased PT and INR, but normal bleeding time. Can also occur after prolonged use of broad-spectrum antibiotics.

Question 22

Zinc deficiency

Answer 22

Delayed wound healing, hypogonadism, alopecia (axillary, facial, pubic), dysgeusia, anosmia, acrodermatitis enteropathica. May predispose to alcoholic cirrhosis.

Question 23

Dermatitis, diarrhea, and alopecia while on long-term total parenteral nutrition (TPN); deficiency?

Answer 23

Zinc deficiency