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NBME 24 Answers

nbme24/Block 2/Question#23

A 9-year-old boy who was adopted from an African ...


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Vitamin B12 is the distractor in this question because it also causes a broad-based, ataxic gait and decrease in vibration. But - Vitamin B12 will not have symptoms like Hemolytic Anemia (decreased hemoglobin, increased LDH). Vitamin E = answer, see below for explanation.

gonyyong  Also the MCV was normal, not megaloblastic like you would see in B12 deficiency +7  

 +6  upvote downvote
submitted by dbg(64),

WTF is "weakness of plantar dorsiflexion" ????? it's like saying "extension flexion" This is not the only obvious technical mistake in the new NBMEs ...

karthvee  loool +2  
yex  Funny Board!! Yeahhhhh +  

 +3  upvote downvote
submitted by karljeon(49),

Vitamin E deficiency causes hemolytic anemia, acanthocytosis, muscle weakness, posterior column and spinocerebellar tract demyelination.

karljeon  Can anyone explain why the serum lactate dehydrogenase (LDH) level was elevated? +  
asapdoc  Vitamin E is an antioxidant. Thus a deficiency can cause hemolytic anemia. +4  
sympathetikey  @karljeon Intravascular hemolysis = LDH release from RBCs +1  

just for addition - here MCV is normal, in B12 deficiency it is high