Vitamins + Associated Deficiency Syndromes

Question 1

Dry, scaly skin + corneal degeneration + night blindness + immunosuppression + bitot spots on conjunctiva

Answer 1

Vitamin A deficiency

Question 2

N/V + vertigo + blurred vision

Answer 2

Acute Vitamin A toxicity

Question 3

Alopecia, dry skin, hepatotoxicity and enlargement, arthralgias, pseudotumor cerebri

Answer 3

Chronic Vitamin A toxicity

Question 4

Which vitamins are teratogenic?

Answer 4

Vitamin A (need negative UPT before Isotretinoin for acne)

Question 5

Confusion, ophthalmoplegia, ataxia + confabulation, personality change, permanent memory loss

Answer 5

Wernicke-Korsakoff syndrome = Vitamin B1 (thiamine) deficiency in alcoholics

Question 6

Polyneuritis, symmetrical muscle wasting

Answer 6

Dry Beriberi = Vitamin B1 (thiamine) deficiency in malnutrition

Question 7

High-output cardiac failure (dilated cardiomyopathy) + edema

Answer 7

Wet Beriberi = Vitamin B1 (thiamine) deficiency in malnutrition

Question 8

Which vitamin deficiency is characterized by impaired glucose breakdown and worsened ATP depletion following glucose infusion?

Answer 8

Vitamin B1 (Thiamine)

B1 is a cofactor for pyruvate dehydrogenase (links glycolysis to TCA), alpha-ketoglutarate dehydrogenase (TCA), transketolase (HMP shunt), and branched-chain ketoacid dehydrogenase

Diagnosis = increase in RBC transketolase activity following B1 administration

Question 9

Cheilosis (inflammation of lips, scaling, and fissures at corners of mouth) + corneal vascularization

Answer 9

Vitamin B2 (riboflavin) deficiency

Question 10

Which vitamin is a component of FAD and FMN, two cofactors in redox reactions?

Answer 10

B2 (riboflavin)

Question 11

Macrocytic, megaloblastic anemia + hypersegmented PMNs + glossitis + NO neurologic symptoms

Answer 11

Vitamin B9 (folate) deficiency

Can be caused by several drugs– phenytoin, sulfonamides, MTX

Commonly seen in alcoholism and pregnancy (can cause NTDs)

Question 12

Decreased homocysteine, normal methylamalonic acid level = what vitamin deficiency?

Answer 12

Vitamin B9 (folate)

Contrast with B12 deficiency:
- increased serum homocystein and methylmalonic acid levels

Question 13

Which vitamin is important for the synthesis of nitrogenous bases in DNA and RNA?

Answer 13

Folate (B9) which is converted to THF in order to do so

Question 14

Dermatitis + alopecia + enteritis in someone who was just on antibiotics or consumes a lot of raw egg whites

Answer 14

Biotin (B7) deficiency

Avidin in egg whites avidly binds B7 –> decreased biotin

Question 15

Which vitamin is a cofactor for carboxylation enzymes (which add a 1-carbon group)?

Answer 15

Vitamin B7 (biotin)

cofactor for:

• pyruvate carboxylase (Glycolysis)
• AcCoA carboxylase (FA ox)
• propionyl-CoA carboxylase (FA ox)

Question 16

Glossitis

If severe: Diarrhea, Dementia, Dermatitis (broad collar/casal’s necklace + hyperpigmentation)

Answer 16

Vitamin B3 (Niacin)

3 Ds = Pellagra

Question 17

Niacin synthesis requires what 3 things?

Answer 17

Tryptophan = Niacin precursor

Vitamin B2 (riboflavin)
Vitamin B6 (pyridoxine)

Question 18

Which vitamin can be used to treat dyslipidemia?

Answer 18

Niacin (B3) lowers VLDL, increases HDL

Question 19

Which vitamin is a constituent of NAD+ and NADP+?

Answer 19

Niacin (B3)

Question 20

What are some causes of Niacin deficiency?

Answer 20

Hartnup disease (decreased tryptophan absorption)

Malignant carcinoid syndrome (increased tryptophan metabloism)

Isoniazid use (depletes B6)

Question 21

Facial flushing, hyperglycemia, hyperuricemia

Answer 21

Vitamin B3 (Niacin) excess

avoid facial flushing by taking Aspirin with Niacin

Question 22

Dermatitis, enteritis, alopecia, adrenal insufficiency

Answer 22

Vitamin B5 (Pantothenic acid) deficiency

Question 23

Which vitamin is an essential component of CoA and FA synthase?

Answer 23

Vitamin B5 (Pantothenic acid)

Question 24

Convulsions, hyperirritability, peripheral neuropathy (inducible by isoniazid and OCPs), sideroblastic anemia (d/t impaired Hb synthesis and iron excess)

Answer 24

Vitamin B6 (pyridoxine) deficiency

Question 25

Which vitamin can be converted to a cofactor used in transamination and carboxylation reactions?

Answer 25

Vitamin B6 (pyridoxine)

Question 26

Which vitamin is important in the syntehsis of cystathionine, heme, niacin, histamine, and NTs (including serotonin, Epi, NE, DA, and GABA)

Answer 26

Vitamin B6 (pyridoxine)

Question 27

Macrocytic, megaloblastic anemia + hypersegmented PMNs + paresthesias and subacute combined degeneration

Answer 27

Vitamin B12 (cobalamin) deficiency

Question 28

What is subacute combined degeneration and which vitamin deficiency causes it?

Answer 28

Degeneration of dorsal columns, lateral corticospinal tracts and spinocerebellar tracts Due to B12 (Cobalamin) deficiency

Question 29

Which vitamin deficiency manifests as increased serum homocysteine and increased methylmalonic acid levels?

Answer 29

B12 (cobalamin)

Question 30

What causes vitamin B12 deficiency

Answer 30

B12 is found only in animal products Insufficient intake (veganism) Malabsorption (sprue, enteritis, diphyllobothrium latum) Lack of IF (pernicious anemia, gastric bypass) Absence of terminal ileum (crohn's)

Question 31

Which vitamin facilitates iron absorption by reducing it to Fe2+?

Answer 31

Vitamin C (ascorbic acid) can be used as ancillary treatment for methemoglobinemia

Question 32

What is vitamin C's role in collagen synthesis?

Answer 32

hydroxylation of proline and lysine

Question 33

What does vitamin C have to do with dopamine?

Answer 33

Vitamin C is necessary for dopamine B-hydroxylase, which converts dopamine to NE

Question 34

swollen gums, bruising, petechiae, hemarthrosis, anemia, poor wound healing, perifollicular and subperiosteal hemorrhages, "corkscrew hair" + weakened immune response

Answer 34

Vitamin C (ascorbic acid) deficiency AKA Scurvy

Question 35

N/V/D, fatigue, calcium oxalate nephrolithiasis, increased risk of iron toxicity in predisposed individuals

Answer 35

Vitamin C (ascorbic acid) excess

Question 36

What is the active form of Vitamin D

Answer 36

1,25-(OH)2 D3 = calcitrol = active form D2 is ingested from plants (ergocalciferol) D3 is consumed in milk, found in sun-exposed skin (cholecalciferol) 25-OH D3 = storage form

Question 37

Bone pain and deformity (rickets) in children Bone pain and muscle weakness (osteomalacia) in adults can also cause hypocalcemic tetany

Answer 37

Vitamin D deficiency Vit D should be supplemented in breastfed infants hypocalcemic tetany because D increases intestinal absorption of calcium and phosphate

Question 38

Hypercalcemia, hypercalciuria, loss of appetite, stupor

Answer 38

Vitamin D excess Seen in granulomatous disease (increased activation of vitamin D by epithelioid macrophages)

Question 39

Which vitamin can enhance the anticoagulant effects of Warfarin

Answer 39

Vitamin E (tocopherol/tocotrienol)

Question 40

Hemolytic anemia, acanthocytosis, muscle weakness, posterior column and spinocerebellar tract demyelination

Answer 40

Vitamin E deficiency Similar to B12 deficiency but lacks megaloblastic anemia, hypersegmented PMNs, and increase in serum methylmalonic acid

Question 41

Which clotting factors require vitamin K for maturation

Answer 41

II, VII, IX, X + proteins C and S Vit K = cofactor for gamma-carboxylation of glutamic acid residues

Question 42

Neonatal hemorrhage with increased PT and aPTT but normal bleeding time

Answer 42

Vitamin K deficiency Hemorrhage can also occur after prolonged use of broad-spectrum abx, as Vit K is synthesized by intestinal flora

Question 43

Delayed wound healing, hypogonadism, decrease in adult hair, dysgeuisa, anosmia, acrodermatitis enteropathica

Answer 43

Zinc deficiency Zinc is essential for the activity of 100+ enzymes (zinc fingers = TF motif)