Name: Vazira Moosajee

Theme: Nutrition

OPTION LIST

A	Vitamin A deficiency	I	Vitamin B1 deficiency
B	Folic Acid deficiency	J	Vitamin E deficiency
C	Vitamin B6 deficiency	K	Vitamin B12 deficiency
D	Magnesium deficiency	L	Copper deficiency
E	Vitamin C deficiency	M	Vitamin D deficiency
F	Sodium deficiency	N	Vitamin C excess
G	Iron deficiency	O
H	Vitamin K deficiency	P

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

Select the appropriate condition from the list above

1. An 85 year old smoker lady is brought to the GP by concerned relatives. She lives alone and has become increasingly withdrawn. On close questioning it appears that over the past few months she has been smoking more heavily and surviving on little more than tea and toast.

On examination she is found to have swollen bleeding gums. Her skin shows a hyper- keratotic rash with petechial haemorrhages and corkscrew hairs

2. A 39 year old house wife is referred to clinic with a 6 month history of fatigue and depression. She also gives a one month history of tingling in her fingers and toes at night

On examination: She is a pale lady with blue eyes. Her examination is normal with the exception of bilateral loss of vibration sense below the knees.

A blood count was performed showing severe macrocytic anaemia which further investigation found to be megaloblastic. The blood film showed oval macrocytes and hyper-segmented neutrophils

Gastric biopsies revealed severe atrophic gastritis. The presence of anti parietal cell antibodies were also detected in her serum

3. An 18 year old cystic fibrosis sufferer presents to A&E, with a long history of severe steatorrhoea. Recently he has started to bruise easily and experience severe protracted nose bleeds. The patient is now distraught after the onset both melena and haematuria today.

4. A young Muslim woman presents to her GP complaining of generalised pain in her muscles which “hurts her down to her bones” and tiredness as even getting up from a chair is difficult.

On examination the lady is found to be completely normal with the exception of a waddling gait. Blood tests done show her to have a low serum calcium and phosphate, and a raised serum alkaline phosphate.

5. A 56 year old is man found unconscious on the street and is admitted to A&E. On regaining consciousness he is found to be long standing alcoholic.

On examination he is found to have nystagmus, peripheral neuropathy and mild pedal. During the course of the examination it becomes obvious that he confabulates to hide in order to try to hide poor memory

ANSWERS

1. E

2. K

3. H

4. M

5. I