Vitamins

Question 1

celiac sprue

Answer 1

gluten entropathy

Question 2

celiac sprue diagnostics

Answer 2

IgA tissue transglutaminase (tTG) antibody

Question 3

lactose intolerance aka

Answer 3

lactase deficiency

Question 4

bloating, abdominal cramping/pain, flatulence

Answer 4

lactose intolerance

Question 5

diagnostic test for lactose intolerance

Answer 5

hydrogen breath test

Question 6

lactose restriction may lead to…

Answer 6

osteoporosis

Question 7

tropical sprue

Answer 7

enviornmental enteropathy

Question 8

biopsy results for tropical and celiac sprue

Answer 8

jejunal biopsy shows flattening of intestinal villi

Question 9

non-IgE mediated reaction example

Answer 9

celiac’s

Question 10

MCC of oral allergy syndrome

Answer 10

tree pollen

Question 11

diagnostic for cystic fibrosis

Answer 11

meconium ileus of newborn

Question 12

vitamin A clinical manifestations

Answer 12

night blindness
squamous metaplasia (conjunctiva, respiratory epithelieum, urinary tract mucosa)
bitot spots (white patches on conjunctiva)
keratomalacia (corneal ulceration and necorsis)

Question 13

vitamin B1 AKA

Answer 13

thiamine

Question 14

b) Significant peripheral vasodilation
c) High output HF with cardiomegaly
d) Dyspnea, tachypnea
e) Pulmonary and peripheral edema
Warm extremities

Answer 14

wet beriberi (high output cardiac failure) of thiamine (B1) deficiency

Question 15

a) Changes to central and peripheral nervous systems
i) i) Peripheral involvement
One. Symmetric motor and sensory neuropathy with associated pain, paresthesia, depression of reflexes
ii) CNS involvement

One. nystagmus
Two. amnesia, impaired learning/memory

Answer 15

Dry beriberi (neurological) of thiamine (B1) deficiency

Question 16

nystagmus leading to ophthalmoplegia, truncal ataxia, confusion

Answer 16

Wernicke encephalopathy (dry beriberi of thiamine (b1) deficiency)

Question 17

‘amnesia, confabulation, impaired learning/memory

Answer 17

Korsakoff syndrome (dry beriberi of thiamine (b1) deficiency)

Question 18

vitamin B2 AKA

Answer 18

riboflavin

Question 19

i. Cheilosis (severe cracking of the lips)
ii. Angular stomatitis
iii. Glossitits (sore tongue/throat)
iv. Seborrheic dermatitis
v. Corneal vascularization
vi. Weakness
vii. Anemia

Answer 19

vitamin B2 riboflavin

also looks like B3 (niacin), B6 (pyridoxine) deficiencies

Question 20

Vitamin B3 AKA

Answer 20

niacin, pellagra

Question 21

1) Dermatitis: photosensitive, symmetric, skin-exposed areas (dark, dry, scaling)
2) Diarrhea: can be severe, malabsorption due to intestinal villi atrophy
3) Dementia: insomnia, irritability, apathy (confusion, memory loss, hallucinations, psychosis)
4) Death may occur

Answer 21

vitamin B3 niacin - pellegra advanced disease

Question 22

3 D’s

Answer 22

dermatitis, diarrhea, dementia (sometimes death) in vitamin B3 niacin deficiency

Question 23

Vitamin B6 AKA

Answer 23

pyridoxine

Question 24

Isoniazid

Answer 24

given with B6 (pyridoxine)

Question 25

Vitamin B12 AKA

Answer 25

cyancobalamin

Question 26

absorption of B12

Answer 26

terminal ileum with intrinsic factor

Question 27

MCC of B12 deficiency

Answer 27

pernicious anemia: lack intrinsic factor

Question 28

Risk factor for B12

Answer 28

Chron's disease

Question 29

Differentiation between B12 and FA

Answer 29

1) Demyelination in posterior columns in lateral corticospinal tracts, and spinocerebellar tracts 2) Loss of proprioception Urinary/fecal incontinence, impotence Neurological symptoms

Question 30

Serum B12 low, methylmalonic acid and homocysteine levels are high

Answer 30

Megaloblastic anemia

Question 31

How much FA is stored

Answer 31

3 months

Question 32

Risk factors of FA deficiency

Answer 32

1) Tropical sprue 2) Poor diet, alcoholism 3) Concurrent vitamin B12 deficiency 4) Drugs: phenytoin, sulfonamides 5) Use of folate antagonists: methotrexate 6) Increased demand: pregnancy, exfoliative skin disease, chronic hemolytic anemia

Question 33

Vitamin C AKA

Answer 33

ascorbic acid

Question 34

i. Bleeding gums ii. Perifollicular hemorrhages iii. Perifollicular papules, petechiae, purpura iv. Splinter hemorrhages v. Hemarthroses

Answer 34

Vitamin C (ascorbic acid) deficiency

Question 35

hemarthrosis in absence of trauma

Answer 35

scurvy

Question 36

Most common cause of osteomalacia in adults and Rickett's in kids

Answer 36

Vitamin D deficiency

Question 37

1) Delayed growth, muscle weakness, pain in the spine/pelvis/legs, thickening of wrists and ankles, bow legged or knock-knee, kyphoscoliosis or lumbar lordosis, costochondral joint thickening

Answer 37

Rickets (vitamin D deficiency in children)

Question 38

1) Typically ASx at first 2) Bone and join pain 3) Reduce muscle strength and endurance 4) Pathologic fractures

Answer 38

Osteomalacia in adult Vitamin D deficiency

Question 39

Serum diagnostics of Vitamin D deficiency

Answer 39

25 (OH) Vitamin D3

Question 40

Vitamin D3 AKA

Answer 40

cholecalciferol

Question 41

i. Muscle weakness and myalgias ii. Absence or depressed reflexes iii. Ataxia (gait disturbances) iv. Decreased vibratory and proprioceptive sensation v. Ophthalmoplegia

Answer 41

Vitamin E deficiency

Question 42

Copper ring around irirs

Answer 42

kayser-fleischer ring

Question 43

a. Hepatic manifestations in teenagers with neuropsychiatric findings b. Consider in any child/young adult with… i. Hepatitis ii. Splenomegaly with hypersplenism iii. Coombs-negative hemolytic anemia iv. Portal HTN v. Neurologic or psychiatric abnormalities c. Dysarthria, dysphagia, incoordination, spasticity d. Migraines, insomnia, seizures e. Behavior and personality changes, emotional lability

Answer 43

Wilson's disease

Question 44

Gold standard diagnosis of Wilson's disease

Answer 44

biopsy of liver

Question 45

treatment for Wilson's disease

Answer 45

oral penicillamine or trientine