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  #1  
Old 01-06-2012
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Biochemistry Vitamin Questions

Courtesy Ms Patho

A 18-year-old girl with cystic fibrosis is brought by her father to her primary care physician with complaints of frequent stumbling on ambulation and difficulty maintaining steadiness of posture when sitting. These symptoms have progressed slowly over the last 2 months. Vital signs are normal. Physical exam shows a limited upward gaze nystagmus, decreased deep tendon reflexes, decreased proprioception and vibratory sense, and distal muscle weakness. The patient also has a profoundly impaired ability to perform finger-nose and rapid alternating movement tests.

select the most likely vitamin deficiency.

Answer Choices
A. Vitamin A deficiency
B. Vitamin B12 deficiency
C. Vitamin C deficiency
D. Vitamin D deficiency
E. Vitamin E deficiency
F. Thiamine deficiency
G. Pyridoxine deficiency
H. Folate deficiency
I. Biotin deficiency


case 2
A 20-year-old male patient is admitted to the hospital 6 months ago following a motorcycle accident resulting in a severe closed head injury. The man has experienced recurrent fungal skin infections resistant to treatment for 1 month and severe vomiting over the last 2 days. Review of the patient's records shows he was well before the injury. He now suffers severe permanent cognitive impairment and requires continuous high-dose phenytoin therapy to manage chronic debilitating tonic-clonic seizures. The patient is resting comfortably in no apparent distress. He is unable to converse coherently. Vital signs are normal. Physical exam is striking for nearly total alopecia. A periorofacial erythematous macular rash is present along with severe seborrheic dermatitis and several truncal ringlike lesions consistent with tinea corpus infection.
select the most likely vitamin deficiency.
Answer Choices
A. Vitamin A deficiency
B. Vitamin B12 deficiency
C. Vitamin C deficiency
D. Vitamin D deficiency
E. Vitamin E deficiency
F. Thiamine deficiency
G. Pyridoxine deficiency
H. Folate deficiency
I. Biotin deficiency
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  #2  
Old 01-06-2012
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B12 deficiency for the first one since r-binding proteins aren't cleaved off. But I guess vitamin e deficiency has the same presentation. How do I differentiate the two of them? :-\

....no clue as to the second question .

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Last edited by 587964; 01-06-2012 at 12:09 PM.
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  #3  
Old 01-06-2012
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Quote:
Originally Posted by smanthrav View Post
B12 deficiency for the first one since r-binding proteins aren't cleaved off. But I guess vitamin e deficiency has the same presentation. How do I differentiate the two of them? :-\

....no clue as to the second question .

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cystic fibrosis-malabsorption of fat soluble vitamis
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  #4  
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Quote:
Originally Posted by MedicalExaminer View Post
cystic fibrosis-malabsorption of fat soluble vitamis
Well yeah but won't there be deficiency in vitamin b12 absorption? I just looked it up in goljan RR under B12. ::

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  #5  
Old 01-06-2012
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Q1'

Spinocerebellar ataxia,,,,vit E deficiency


Q2'

Pyridoxine def...as the patient is on anticonvulsants ,which can cause it's def and dermatological symptoms.
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  #6  
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first case go with Vit B 12
second one I dont know
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  #7  
Old 01-06-2012
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Case 1.
Vit E defeciency

Case 2

Vit A defeciency
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  #8  
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First Q ans Is Vit E

Second Q ans is Biotin as alopecia is present but cannot figure out why the deficiency should arise in this patient.
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Old 01-07-2012
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I think the answer
the 2nd case is hard
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Old 01-07-2012
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Ans to 1st qs Vit E deficiency ... but i think Vit B12 would also cause similar symptoms ???? if any one could please explain ...

Ans to 2nd QS is Folate deficiency because phenytoin causes decrease in folate absorption ( first aid ) which leads to decrease in dna production and hence imparied cell mediated and recurrent fungal infections ....
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Old 01-07-2012
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Quote:
Originally Posted by Hitman View Post
Ans to 1st qs Vit E deficiency ... but i think Vit B12 would also cause similar symptoms ???? if any one could please explain ...

Ans to 2nd QS is Folate deficiency because phenytoin causes decrease in folate absorption ( first aid ) which leads to decrease in dna production and hence imparied cell mediated and recurrent fungal infections ....
I go with u hitman..........
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  #12  
Old 01-07-2012
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Quote:
Originally Posted by Poonam aslam View Post
Q1'

Spinocerebellar ataxia,,,,vit E deficiency


Q2'

Pyridoxine def...as the patient is on anticonvulsants ,which can cause it's def and dermatological symptoms.
i go with poonam aslam's.
1 Ataxia here altho Spinocerebellar ataxia makes me think of the triplet expansion genetic disorder

2 Pyridoxine B6 def causes Convulsions, skin problems, cheilosis

Last edited by ab_baby; 01-07-2012 at 11:40 AM.
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  #13  
Old 01-07-2012
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Are these types of questions that people put up from a random qbank, or are they "nbme style discussion/rephrased questions" lol..Just asking cuz if so, I could start looking at them as well.
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  #14  
Old 01-08-2012
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question 1 - thiamine defeciency ?!?!?
question 2 - vit a def
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  #15  
Old 01-08-2012
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Help I go for...

1. I think is thiamine (Beriberi???)
2. I think is vit E... somewhere in Goljan audios mentioned skin lesions like this or something like this.
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Old 01-08-2012
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Case1-vitamin E (posterior column and spinocerebellar tract degeneration)

2-Biotin (rare, alopecia, dermatitis) (not sure about fungal infection-more than one vitamin deficiency can be related to fungal infection)
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Old 01-09-2012
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Default ....???

And the answer???
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  #18  
Old 01-09-2012
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Default Hospitals in Bellandur

What are some good foods that contain vitamins for a 9 year old?
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Old 01-20-2012
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phenytoin decreases folate absorption by inhibiting intestinal conjugase. if the deficiency is severe enough, it can lead to pancytopenia. pancytopenia can lead to a fungal infection. a fungal infection such as tinea capitis can cause alopecia. hope that helps.
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  #20  
Old 01-21-2012
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I think indigo's answer is right.

Prolonged use of certain drugs, especially phenytoin, primidone, and carbamazepine, may lead to biotin deficiency; however, valproic acid therapy is less likely to cause this condition.[9] Some anticonvulsants inhibit biotin transport across the intestinal mucosa. Evidence suggests that these anticonvulsants accelerate biotin catabolism. Therefore, supplemental biotin, in addition to the usual minimum daily requirements, has been suggested for patients who are treated with anticonvulsants that have been linked to biotin deficiency.

http://en.wikipedia.org/wiki/Biotin_...nfirmed_Causes
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  #21  
Old 01-21-2012
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whats the answer???

i think
1) vit.E (although im just choosing that over B12 because its a cystic fibrosis patient, not sure why else you would disclude b12 because it seems correct)
2) Biotin

???
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Old 01-21-2012
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Quote:
Originally Posted by deeqwerty View Post
I think indigo's answer is right.

Prolonged use of certain drugs, especially phenytoin, primidone, and carbamazepine, may lead to biotin deficiency; however, valproic acid therapy is less likely to cause this condition.[9] Some anticonvulsants inhibit biotin transport across the intestinal mucosa. Evidence suggests that these anticonvulsants accelerate biotin catabolism. Therefore, supplemental biotin, in addition to the usual minimum daily requirements, has been suggested for patients who are treated with anticonvulsants that have been linked to biotin deficiency.

http://en.wikipedia.org/wiki/Biotin_...nfirmed_Causes
but how does biotin deficiency cause loss of cell mediated immunity and recurrent fungal infections ??????
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  #23  
Old 07-09-2016
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Smile Answer to second question

Profound biotinidase deficiency can be detected with newborn screening. The first symptoms of biotin deficiency are associated with the skin and hair.

Symptoms develop within 3-5 weeks of the onset of deficient biotin intake. The most common cutaneous findings include the following:

Dry skin
Seborrheic dermatitis
Fungal infections
Rashes, including erythematous periorofacial macular rash
Fine and brittle hair
Hair loss or total alopecia

Approximately 1-2 weeks later, neurologic symptoms begin to develop. The most common neurologic findings include the following:

Mild depression, which may progress to profound lassitude and, eventually, to somnolence
Changes in mental status
Generalized muscular pains (myalgias)
Hyperesthesias and paresthesias
Intestinal tract symptoms also develop and most commonly include the following:

Nausea, occasionally severe
Vomiting
Anorexia

Spastic tetraparesis in a young woman associated with deficiency of biotinidase has been reported.


Causes of biotin deficiency include the following:

Eating raw egg whites
Some mistakenly believe that raw egg-white consumption is the only cause of biotin deficiency. Nonetheless, a diet that contains raw egg whites quickly and almost invariably leads to biotin deficiency.

Total parenteral nutrition without biotin supplementation
Several cases of biotin deficiency in patients receiving prolonged total parenteral nutrition (TPN) therapy without added biotin have been reported. Therefore, all patients receiving TPN must also receive biotin at the recommended daily dose, especially if TPN therapy is expected to last more than 1 week. All hospital pharmacies currently include biotin in TPN preparations.

Anticonvulsant therapy
Prolonged use of certain drugs, especially phenytoin, primidone, and carbamazepine, may lead to biotin deficiency;
however, valproic acid therapy does not cause this condition. Some anticonvulsants inhibit biotin transport across the intestinal mucosa. Evidence suggests that these anticonvulsants accelerate biotin catabolism. Therefore, supplemental biotin, in addition to the usual minimum daily requirements, has been suggested for patients who are treated with anticonvulsants that have been linked to biotin deficiency.

Prolonged oral antibiotic therapy
Prolonged use of oral antibiotics has been associated with biotin deficiency. Alterations in the intestinal flora caused by the prolonged administration of antibiotics are presumed to be the basis for biotin deficiency.

Genetic mutation
Mikati et al reported a case of partial biotinidase deficiency (plasma biotinidase level of 1.3 nm/min/mL) in a 7-month-old boy.[22] The boy presented with perinatal distress followed by developmental delay, hypotonia, seizures, and infantile spasms without alopecia or dermatitis. The child's neurologic symptoms abated following biotin supplementation and antiepileptic drug therapy. DNA mutational analysis revealed that the child was homozygous for a novel E64K mutation and that his mother and father were heterozygous for the novel E64K mutation. We now report 140 known mutations in the biotinidase gene (BTD) that cause biotinidase deficiency.

Ketogenic diet (high-protein, low-fat)
In a mouse model, a ketogenic diet exaggerated biotin deficiency.
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  #24  
Old 08-04-2016
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What do people find to be the most tested vitamin?
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vitamins are very essential for the human body to keep healthy.
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Default vitamin for skin care

Skin that has healthy glow usually comes from inside and for many people it comes with a healthy lifestyle. Vitamin C is very important for the production of collagen, which is very essential to keep skin healthy. My sister was also facing the saggy skin issue after the weight loss program so she tried the collagen drink, which has various mineral, vitamin and anti-oxidants, which will help to restore the skin. One can view online this collagen supplement which will help to rebuild the skin.
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Thanks for sharing informative piece.
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Case 1 is vit B12 deficiency
Case 2 is Biotin deficincy ( Alopecia, dermatitis
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