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  #1  
Old 04-21-2011
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Arrow Vitamins deficiency practice cases

Hi all,

Let's practise vitamin deficency senarios! Here are 3 cases! Please add more if you wish to share!

1. An epileptic young man with alopecia, severe seborrheic dermatitis and several truncal ringlike lesions


2. A yound woman with inflammatory bowel disease, frequent spontaneous abortions, frequent upper respiratory tract infection, dry hair and skin, broken fingernails, foamy grey conjunctival patches

3. A young man with cystic fibrosis, presented with frequent stumbling, nystagmus, decreased deep tendon reflexes, decreased proprioception and vibratory sense, and distal muscle weakness



A. Vitamin A
B. Vitamin B12
C. Vitamin C
D. Vitamin D
E. Vitamin E
F. Folate
G. Biotin
H. Thiamine
I. Vitamin B6
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Old 04-21-2011
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i tot number 1 was niacin def. but its not in the options..

number 3 should be vit b6?
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Old 04-21-2011
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1. Probably biotin (of the choices listed - like Seetal, I would like niacin for this one. 3rd and 4th choices would be riboflavin and pyridoxine?)

2. Vitamin A
Bitot's spot:


3. Vitamin E
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Old 04-21-2011
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why not B12 for Q# 3
1. B6 ?
2.Vitamin A.
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Old 04-22-2011
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Quote:
Originally Posted by Mondoshawan View Post
1. Probably biotin (of the choices listed - like Seetal, I would like niacin for this one. 3rd and 4th choices would be riboflavin and pyridoxine?)

2. Vitamin A
Bitot's spot:


3. Vitamin E
Good job Mondoshawan!
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can u explain y is number 3 due to vit E def pls? thx.
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Old 04-22-2011
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Default Biotin deficiency!

Biotin deficiency is relatively rare except, classically, in patients who regularly consume raw egg whites. Phenytoin in particular among several antiseizure medications has a well-recognized association with biotin deficiency. Alopecia, treatment-resistant fungal skin infections, seborrheic keratitis, and vomiting are typical consequences of biotin deficiency.

Biotin
Biotin is important for carboxylation reactions. Biotin is normally synthesized by intestinal flora. It serves as a coenzyme in multienzyme complexes involved in carboxylation reactions. It is important in lipogenesis, gluconeogenesis, and the catabolism of the branched-chain amino acids. The majority of the requirement for biotin is met from synthesis in the bowel by intestinal bacteria. Consumption of raw eggs can cause biotin deficiency because the egg-white protein, avidin, combines with biotin, preventing its absorption. Interestingly, certain inherited single or multiple carboxylase deficiencies can also lead to apparent biotin deficiency syndrome. Symptoms of biotin deficiency include depression, hallucinations, muscle pain and dermatitis. Children with multiple decarboxylase deficiency also demonstrate immunodeficiency disease.

From Medical Biochemistry 2E by Baynes & Dominiczak
(source USMLE consult)
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Post thx and this is what i got on vit E def.



Vitamin E deficiency causes neurological problems due to poor nerve conduction. These include neuromuscular problems such as spinocerebellar ataxia and myopathies. Deficiency can also cause anemia, due to oxidative damage to red blood cells.


Vitamin E deficiency is rare and is almost never caused by a poor diet.Instead, there are three specific situations when a vitamin E deficiency is likely to occur. It is seen in persons who cannot absorb dietary fat, has been found in premature, very low birth weight infants (birth weights less than 1500 grams, or 3.5 pounds), and is seen in individuals with rare disorders of fat metabolism.


Abnormalities relating vitamin E deficiency progress from hyporeflexia, ataxia, limitation in upward gaze, and strabismus to long-tract defects, including visual-field constriction and profound muscle weakness.



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Quote:
Originally Posted by Seetal View Post


Vitamin E deficiency causes neurological problems due to poor nerve conduction. These include neuromuscular problems such as spinocerebellar ataxia and myopathies. Deficiency can also cause anemia, due to oxidative damage to red blood cells.


Vitamin E deficiency is rare and is almost never caused by a poor diet.Instead, there are three specific situations when a vitamin E deficiency is likely to occur. It is seen in persons who cannot absorb dietary fat, has been found in premature, very low birth weight infants (birth weights less than 1500 grams, or 3.5 pounds), and is seen in individuals with rare disorders of fat metabolism.


Abnormalities relating vitamin E deficiency progress from hyporeflexia, ataxia, limitation in upward gaze, and strabismus to long-tract defects, including visual-field constriction and profound muscle weakness.


Well done! Thanks Seetal!
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Default Case-3

Patients with cystic fibrosis are at risk for vitamin E deficiency.

In humans, vitamin E deficiency is very rare and is seen virtually only in:

1. Premature infants, causing hemolytic anemia of the newborn.

2. Children and adults, secondary to severe fat malabsorption. For example, biliary atresia, cholestatic liver disease, or a lipoprotein deficiency (e.g. abetalipoproteinemia).
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