Vitamins -Fahim Flashcards
You receive a report from the laboratory that a 1-year-old patient of yours who has experienced poor growth has an elevated sweat chloride level. The serum concentration of which of the following vitamins would you expect to be normal? A. A B. C C. D D. E E. K
B. C
CF problem with fat soluble vitamins (ADEK)
What foods have a high Vitamin A content? What happens with Vitamin A deficiency?
carrots and veggies
deficiency: Night blindness, conjunctival xerosis, Bitot spots, keratomalacia (irreversible), worsens morbidity of the measles
What is the most common cause of preventable blindness in children worldwide?
Vitamin A deficiency
What are some symptoms of too much Vitamin A (vitamin A toxicity)?
Increased ICP (pseudotumor cerebri), dizziness, nausea, headaches, skin irritation, pain in joints and bones, coma, and even death
What are some clinical manifestations of Vitamin E Deficiency?
Symptoms or “Eging” (like aging but with an E)
Myopathy Ataxia Pigmented retinopathy with vision loss Loss of vibratory and position sense Hyporeflexia Generalized weakness Hemolytic anemia
How is Vitamin E deficiency measured?
< 5 mg/L serum alpha-tocopherol
A 9-month-old African American boy comes in for his first visit. He has just moved from upstate New York, having received only sporadic well-care since his birth in September. He has been breastfed exclusively, and his length is at the 3rd percentile. Which of the following blood tests would you expect might yield an abnormal result? A. Alanine aminotransferase. B. Alkaline phosphatase. C. Blood urea nitrogen. D. Glucose. E. Uric acid
B. Alkaline phosphatase.
Infants that are purely breast fed should supplement with vitamin D
expect high alk phos and low Ca2+ and phos.
A 63 year old man who is an alcoholic is brought into the ED by his daughter. She states that the patient’s memory has been very poor and he constantly creates elaborate yet untrue stories. Physical examination reveals ataxia and bilateral horizontal nystagmus. Wernicke-Korsakoff syndrome, caused by water-soluble deficiency, is suspected. Which of the following conditions is also a result of a water soluble vitamin deficiency? A. Increased erythrocyte hemolysis B. Neonatal hemorrhage C. Night blindness D. Osteomalacia E. Pellagra
E. Pellagra (vitamin B3 (niacin) deficiency)
What causes A. Increased erythrocyte hemolysis?
B. Neonatal hemorrhage?
C. Night blindness?
D. Osteomalacia?
A=Vitamin E deficiency
B=Vitamin K deficiency
C=Vitamin A deficiency
D=Vitamin D deficiency
A 17-year-old girl who comes to you as a new patient tells you that she has been eating a strict vegetarian diet for 5 years. You order a complete blood cell count because of concern about which of the following conditions? A. Lymphocytosis. B. Macrocytic anemia. C. Microcytic anemia. D. Normocytic anemia. E. Thrombocytosis.
B. Macrocytic anemia.
B12 deficiency
What can a vitamin B1 deficiency (thiamine) cause?
Wernickes
Beriberi
“Be the One Thai place that will give you Wet Berries”
Thiamine important in Ach synthesis
What is Fahim’s crazy pneumonic for Vitamin B3 problems?
B 3D Nick
B3=niacin
Diarrhea, Dementia and Dermatitis from deficiency =”Pellagra”
A 3 week old boy presents to his pediatrician because his mother has noticed that he “looks yellow.” On questioning, she elaborates that the jaundice began several days after birth and has been associated with dark urine and clay-colored stools. Laboratory studies show a direct bilirubin level of 5.0mg/dL and a total bilirubin level of 5.5mg/dL. Which of the following is characteristic of the most likely diagnosis?
A. Caused by a genetic mutation in a promoter region.
B. Caused by a deficiency in uridine 5’-diphosphoglucuronosyltransferase
C. Commonly treated with phototherapy
D. Inherited in an autosomal dominate pattern
E. Untreated it leads to cirrhosis by six months of age.
E. Untreated it leads to cirrhosis by six months of age.
pt has congenital extrahepatic biliary atresia
When would you see breastfeeding jaundice? What is this due to?
Early onset (in 1st week of life)
due to: decreased caloric intake (milk is not in yet), mild dehydration, delayed passage of meconium
When is Breast Milk Jaundice seen?
6th-14th day of life
Vitamin B6 and B12 deficiencies will both give you ____ symptoms
neurological
What deficiency is associated with microcytic anemia? Macrocytic?
B6- microcytic anemia*
B12= Macrocytic anemia
What population is more likely to get vitamin B 12 deficiency?
vegans
B12 is only in animal products
A 28 year-old previously healthy woman who is six months pregnant comes to the physician complaining of excessive fatigue for the past several months. Physical examination reveals pallor of her mucous membranes. A peripheral smear shows small RBCs containing a narrow rim of hemoglobin in the periphery. Which of the following laboratory values (Ferritin, Iron Binding Capacity and MCV) are most likely to be found in this patient?
Ferritin=low
Iron Binding capacity=high
MCV =low
What is the most common nutritional deficiency in children?
Iron deficiency
can be caused by cows milk
microcytic hypochromatic anemia
A 25 year old woman visits her primary care physician because of fatigue. Laboratory studies show:
WBC: 5000/mm Glucose: 98mg/dL
Hct: 28% Na: 139
Hb: 9.8 g/dL K: 4.3
MCV: 105fL Cl: 101
Platelets: 322 BUN: 15mg/dL
Cr: 0.9mg/dL
A schilling test is performed: A dose of radiolabeled B12 is administered orally and shortly thereafter a nonradiolabeled dose is given via injection. A 24 hour urine collection reveals no B12 excretion. One week later another dose of radiolabeled B 12 is administered along with intrinsic factor. This time B12 excretion in the urine is normal. The secretion of what substance is likely altered?
A. Bicarbonate
B. Gastrin
C. Hydrochloric acid
D. Insulin
E. Trypsin
C. Hydrochloric acid
pt has megaloblastic anemia secondary to pernicious anemia (MCV > 100 and hematocrit problem with intrinsic factor
IF produced by parietal cells
–> will also have problem with HCL because it is secreted by parietal cells
Where is vitamin B6 found?
yeast, rice, polishing and cereals
