Vitamins and Minerals

Question 1

Signs and symptoms of Vitamin A deficiency

Answer 1

Night blindness, scaly rash, xerophthalmia (dry eyes), Bitot spots (debris on conjunctiva), increased infections

Question 2

Signs and symptoms of Vitamin A toxicity

Answer 2

Pseudotumor cerebri, bone thickening, teratogenic

Question 3

Signs and symptoms of Vitamin C deficiency

Answer 3

Scurvy (hemorrhages/skin petechiae, bone, gums; loose teeth; gingivitis), poor wound healing, hyperkeratotic hair follicles, bone pain (from periosteal hemorrhages)

Question 4

Signs and symptoms of Vitamin D deficiency

Answer 4

Rickets, osteomalacia, hypocalcemia

Question 5

Signs and symptoms of Vitamin D toxicity

Answer 5

Hypercalcemia, nausea, renal toxicity

Question 6

Signs and symptoms of Vitamin E deficiency

Answer 6

Anemia, peripheral neuropathy, ataxia

Question 7

Signs and symptoms of Vitamin E toxicity

Answer 7

Necrotizing enterocolitis (infants)
Decreased level of vitamin K dependent clotting factors, potentiates actions of warfarin, increases risk of hemorrhagic stroke

Question 8

Signs and symptoms of Vitamin K deficiency

Answer 8

Hemorrhage, prolonged PT

Question 9

Signs and symptoms of Vitamin K toxicity

Answer 9

Hemolysis (kernicterus)

Question 10

Signs and symptoms of Vitamin B1 (thiamine) deficiency

Answer 10

Wet beriberi (high-output cardiac failure), dry beriberi (peripheral neuropathy), Wernicke and Korsakoff syndromes

Question 11

Signs and symptoms of Vitamin B2 (riboflavin) deficiency

Answer 11

Angular stomatitis, dermatitis

Question 12

Signs and symptoms of Vitamin B3 (niacin) deficiency

Answer 12

Pellagra (dementia, dermatitis, diarrhea), stomatitis

Question 13

Signs and symptoms of Vitamin B6 (pyridoxine) deficiency

Answer 13

Peripheral neuropathy, stomatitis, convulsions in infants, microcytic anemia, seborrheic dermatitis

Question 14

Signs and symptoms of Vitamin B12 (coabalamin) deficiency

Answer 14

Megaloblastic anemia + neurologic symptoms

Question 15

Signs and symptoms of folic acid deficiency

Answer 15

Megaloblastic anemia WITHOUT neurologic symptoms

Question 16

Signs and symptoms of Vitamin B6 (pyridoxine) toxicity

Answer 16

Peripheral neuropathy - ONLY VITAMIN B TOXICITY

Question 17

Signs and symptoms of iron deficiency

Answer 17

Microcytic anemia, koilonychia (spoon-shaped fingernails)

Question 18

Signs and symptoms of iron toxicity

Answer 18

Hemochromatosis

Question 19

Signs and symptoms of iodine deficiency

Answer 19

Goiter, cretinism, hypothyroidism

Question 20

Signs and symptoms of iodine toxicity

Answer 20

Myxedema

Question 21

Signs and symptoms of fluoride deficiency

Answer 21

Dental caries (cavities)

Question 22

Signs and symptoms of fluoride toxicity

Answer 22

Fluorosis with mottling of teeth and bone exostoses

Question 23

Signs and symptoms of zinc deficiency

Answer 23

Hypogeusia (decreased taste), rash, slow wound healing

Question 24

Signs and symptoms of copper deficiency

Answer 24

Menkes syndrome (X-linked; kinky hair, mental retardation)

Question 25

Signs and symptoms of copper toxicity

Answer 25

Wilson disease

Question 26

Signs and symptoms of selenium deficiency

Answer 26

Cardiomyopathy and muscle pain

Question 27

Signs and symptoms of selenium toxicity

Answer 27

Loss of hair and nails

Question 28

Signs and symptoms of manganese toxicity

Answer 28

“Manganese madness” in miners of ore (behavioral changes/psychosis)

Question 29

Signs and symptoms of chromium deficiency

Answer 29

Impaired glucose tolerance

Question 30

What are the fat-soluble vitamins? In what general category of patients are they deficient?

Answer 30

Vitamins A, D, E, and K are fat-soluble.
May be due to malabsorption (e.g. CF, cirrhosis, celiac disease, duodenal bypass, bile-duct obstruction, pancreatic insufficiency, chronic giardiasis).

Question 31

What vitamin, mineral, and electrolyte deficiencies are classically seen in alcoholics?

Answer 31

Folate, thiamine, phosphorous, and magnesium deficiencies

Question 32

What is the most common cause of Vitamin B12 deficiency?

Answer 32

Pernicious anemia, in which antiparietal antibodies destroy the ability to secrete intrinsic factor. Conditions associated with pernicious anemia include hypothyroidism, type I diabetes, and vitiligo. Schilling test is used to diagnose the cause of B12 deficiency. Removal of ileum and tapeworm Diphyllobothrium latum are exotic causes.

Question 33

What is the classic iatrogenic cause of Vitamin B6 deficiency?

Answer 33

Prolonged therapy with isoniazid (esp. in young people). Many automatically give pyridoxine supplements to patients who start isoniazid therapy for TB.

Question 34

Which medications may cause folate deficiency?

Answer 34

Anticonvulsants (esp. phenytoin), methotrexate, trimethoprim

Question 35

Which vitamin is a known teratogen?

Answer 35

Vitamin A. Women taking one of the Vitamin A analogs (e.g. isotretinoin) as treatment for acne must have a negative pregnancy test before starting.

Question 36

Which vitamin should be taken by all sexually active women or reproductive age?

Answer 36

Folate, which reduces the risk of neural tube defects in the fetus. The maximal benefit often occurs before the woman knows that she is pregnant.

Question 37

What are the physical findings of rickets?

Answer 37

Craniotabes (poorly mineralized skull; bones feel like a ping-pong ball), rachitic rosary (costochondral beading; small round masses on anterior rib cage), delayed fontanelle closure, bossing of the skull, kyphoscoliosis, bow-legs and knock-knees
*Bone changes first appear at the lower ends of the radius and ulna)

Question 38

Which vitamin is given to all newborns?

Answer 38

Vitamin K is given as prophylaxis against hemorrhagic disease of the newborn.

Question 39

Which clotting factors are affected by Vitamin K? What is the interaction of Vitamin K and the liver?

Answer 39

Needed for hepatic synthesis of factors II, VII, IX, and X as well as proteins C and S.
Chronic liver disease can cause prolongation of PT and INR because of inability to synthesize even in the presence of Vitamin K. Problem should be corrected with fresh frozen plasma.

Question 40

Describe the relationship between Vitamin K and broad-spectrum antibiotics.

Answer 40

Prolonged therapy with broad-spectrum antibiotics is a potential cause of Vitamin K deficiency. These meds can eliminate normal gut bacteria that synthesize much of the Vitamin K required daily.

Question 41

What is the classic description of a Vitamin C-deficient patient?

Answer 41

An elderly person with a diet of “hot dogs and soda” or “tea and toast” who presents with bleeding gums and bone pain.