NBME 23 Dietary change (NBME Answers)

Retired NBME 23 Answers

nbme23/Block 2/Question#44 (reveal difficulty score)
A 4-year-old boy is brought to the physician ...
Dietary change 🔍 / 📺 / 🌳 / 📖
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+33 upvote downvote
submitted by ∗water(47)

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surprisingly, I actually learned this from the Magic School Bus when I was a kid. That's the only reason I got this right. Thanks Ms. Frizzle! :D

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paulkarr She taught me more than my med school professors did... +6

painintheash5 ahahah i remember that episode! +1

meryen13 I think that cartoon is one of the reasons I'm a medical student! lol +1

sd22 That episode flashed in my head when reading this Q and I thought no way... +

+26 upvote downvote
submitted by ∗welpdedelp(270)

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No diet deficiency, the patient had excess carotene due to his diet

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sympathetikey Would never have thought of that. Thanks +11

medschul that's messed up dog +24

hpkrazydesi Excess carotene in what way? sorry if thats a stupid question +

davidw this is directly from Goljan "Dietary β-carotenes and retinol esters are sources of retinol. β-carotenes are converted into retinol. (a) Increased β-carotenes in the diet cause the skin to turn yellow (hypercarotenemia). Sclera remains white, whereas in jaundice the sclera is yellow, which can be used to distinguish the two conditions. (c) Vitamin toxicity does not occur with an increase in serum carotene" +8

davidw β-Carotenes are present in dark-green and yellow vegetables. +1

hyperfukus ohhhh hellllll no +7

dashou19 When I was a little kid, I like to eat oranges, like I could eat 10 oranges at once, and after a few days, I could tell that I turned yellow... +8

cbreland I'm okay with missing this one +4

veryhungrycaterpillar That was fucking stupid. I've known this excess carotene fact since 8th grade due to a friend getting it, but I still wouldn't have thought of it. I went with anemia, figured it had to be folic acid since B6 would have shown up sooner than four years. UGH. +

an1 Vitamin C def would not occur in vegans and would cause scurvy symptoms. Folic Acid is HIGH in green leafy vegetables, We can assume vegans eat a lot of veggies. As this causes a megaloblastic anemia, the sclera would be expected to be pale. IFN a + ribavirin is used for hep, which is ruled out because of the normal urine and stool, and lack of scleral icterus. B1 def presents with wernickes/ Korsakoff often with excess alcohol intake and hypoglycemia uncorrected after dextrose. B6 presents with sideroblastic anemia + peripheral neuropathy (remember that INH caused B6 to be excreted resulting in neuropathy). I got this wrong. Because who has time to go through every option and think it through, and who thought carrots would make the cut for this test. +1

There's an episode in scrubs the person is orange i looked up "too much carrot" they look orange NBME language strikes again

+9/- ergogenic22(401)

+0 upvote downvote
submitted by ∗alexb(53)

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I guess he's taking B12 supplements, otherwise he would have a symptomatic deficiency, right?

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+0 upvote downvote
submitted by ∗imgdoc(183)

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Process of elimination using the stem, this kid has no vitamin deficiencies that correspond to his clinical symptoms. Plus his diet was weird to me, so I selected dietary change.

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submitted by ∗deberawr(12)

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i got this question right only because when i worked as a med assistant in a derm office before med school, the dermatologist looked at my skin and asked me if i was eating a lot of carrots because my skin looked more orange than usual

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drdoom and precisely how many pounds of carrots were you eating? +

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submitted by ∗syoung07(58)

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yall seent that episode of scrubs where homie eats carrots, peppers and tomato juice? He's orange from his diet and otherwise healthy.

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-3 upvote downvote
submitted by ∗samsam3711(31)

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I actually think he might have iron-deficiency anemia that can be described as pallor or "yellowing of the skin." He does not have jaundice (anicteric sclera) Patients who are strict vegans can develop iron deficiency. The best way to correct this is to encourage a dietary change

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123ojm iron deficiency is rare in vegans and vegetarians unless they are also heavily menstruating +

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