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Retired NBME 16 Answers

nbme16/Block 1/Question#24 (reveal difficulty score)
A 16-year-old girl with cystic fibrosis is ...
Vitamin E ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—cassdawg(1781)
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Cystic fibrosis commonly leads to pancreatic insufficiency and thus impaired absorption of the fat soluble vitamins (ADEK). Vitamin E can cause demyelination fo the posterior columns and spinocerebellar tract (FA2020 p60, p70)

Vitamin E deficiency can appear similarly to vitamin B12 deficiency due to the neurologic effects appearing similar, but the history of cystic fibrosis points to fat soluble vitamin E deficiency. Further, B12 deficiency is not a choice.

  • Folic acid (B9) deficiency causes megaloblastic anemia and does not cause neurologic symptoms. Deficiency can be caused by phenytoin, methotrexate, or sulfonamides. Deficiency in pregnancy is associated with neural tube defects.
  • Vitamin A deficiency causes night blindness, dry skin, squamous metaplasia, corneal degeneration, and immunosupression.
  • Vitamin B6 (pyridoxine) deficiency causes sideroblastic anemia, convulsions, hyperirritability, and peripheral neuropathy. Deficiency is commonly associated with isoniazid.
  • Vitamin D deficiency causes rickets in children and osteomalacia in adults (both bone issues) as well as hypocalcemia and associated hypocalcemic tetany.
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fatboyslim  Also remember that vitamin E deficiency does not cause megaloblastic anemia, hypersegmented neutrophils, or elevated serum methylmalonic acid. Vitamin E EXCESS can also alter the metabolism of vitamin K -> ENHANCING the ANTICOAGULANT effects of warfarin (FA 2020 p70). UW 1048 also mentions that vitamin E EXCESS is associated with higher mortality due to hemorrhagic stroke in adults! +



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