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Old 09-06-2014
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Arrow Practice Question #7

A 40 year old man has developed pancreatitis, and with it, steatorrhea. The patient also reports problems with his night vision, although visual acuity appears normal.
Another expected finding in this patient would be which of the following?

(A) Nystagmus
(B) Easy bruising
(C) Dermatitis
(D) Loss of teeth
(E) Orange tonsils
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Old 09-06-2014
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Hmmm, not sure but vit A def so dermatitis.
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Old 09-06-2014
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This Q drives me nuts thats for sure its vit A deficiency i would go with dermatitis
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B

pancreatitis assoc with night blindness hints to me that theres malabsorption of fat sol vitamins adek. vit k def will cause ecchymoses and gi bleeds... so id have to pick B - easy bruising
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Old 09-06-2014
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The answer is B: Easy bruising.
The man, due to the pancreatitis, is not able to adequately digest triglycerides in the intestinal lumen, which is what leads to the steatorrhea. Fat-soluble vitamin absorption is dependent upon triglyceride digestion and absorption, so under these conditions, the patient can become deficient in fat-soluble vitamins (A, D, E, and K). The loss of night vision is an early warning for lack of vitamin A. If the patient is becoming deficient for vitamin K, bruising would become a problem, due to ineffective clotting with slight internal damage.

Nystagmus is a symptom of vitamin B1 deficiency, a water soluble vitamin.
Dermatitis is a symptom of niacin deficiency (vitamin B3).
Loss of teeth can occur with a vitamin C deficiency.
Orange tonsils is indicative of Tangier disease- People with Tangier disease have defective ABCA1 transporters resulting in a greatly reduced ability to transport cholesterol out of their cells, which leads to an accumulation of cholesterol in many body tissues. Reduced blood levels of high-density lipoproteins is sometimes described as hypoalphalipoproteinemia.
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