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NBME 22 Answers

nbme22/Block 4/Question#8 (20.4 difficulty score)
A 6-year-old boy who recently emigrated from ...
Vitamin EπŸ”

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submitted by someduck3(58),
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aFt ublleso mainsitv rea .,,,AKDE So obth D pm&a; E cdoul eb sdeeacder in shti .tp utB you evah to okwn taht nVmiati E nceyecidfi si idaosseatc iwth tlonaeimnidye &;mpa sah eenb escaisdato with rtoeiposr ulmnoc mdaneltoynei.i oAsl itV E can eb eivng itwh izhelremA itepntsa as ti spleh whit free ?.idsa.rlac

aesalmon  I actually thought that the posterior column findings were likely due to B12 deficiency - "subactue combined degeneration", due to malabsorption, as we see in this pt (. Turns out vitamin E can also cause symptoms which look like subacute combined degeneration:, as does Copper (TIL): +3  
jooceman739  Vitamin E deficiency causes posterior column findings and hemolytic anemia :) +5  
nwinkelmann  The way I think about it is that essentially, vitamin E is an anti-oxidant. Vitamin E deficiency = LOTS of oxidation, i.e. free radicals, which are toxic to most cells in the body (particularly myelination and RBCs). That's why it can be used with Alzheimer's patients. +3  
makinallkindzofgainz  Vitamin E presents like B12 deficiency but without megaloblastic anemia +  
kevin  B12 would also affect lateral corticospinal tracts, vit E doesn't to my knowledge (b12 deficiency would also present with hyperreflexia but E deficiency just romberg sign, loss of proprioception and touch, ataxia) +  

submitted by alexb(45),
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I nikth ethes'r a oWrdUl nqoituse dcnsrebgii hwo cycits bsiifosr acn asuce aft obulles atniivm cnfciidyee dan woh a tVi E fde in tath encttxo migth tfaesnmi rialimsly to B12 fd.e slAo( ni rftsi )ida

submitted by dentist(49),

Ataxia due to vitamin deficiency can only be caused by Thiamine or Vitamin E deficiency.