Name: James Murray

Theme: Nutrition

 

OPTION LIST

 

A

Folate

I

Vitamin E

B

Nicotinic Acid (Niacin)

J

Vitamin K

C

Vitamin A

K

 

D

Vitamin B1 (Thiamin)

L

 

E

Vitamin B6 (Pyridoxine)

M

 

F

Vitamin B12 (Cobalamin)

N

 

G

Vitamin C

O

 

H

Vitamin D

P

 

 

For each of the patients listed below, select the most likely vitamin deficiency from the above list

 

1. A 50-year-old unemployed actor who lives in a lighthouse and is an alcoholic, presents at a sea hospital with peripheral neuropathy and worsening loss of memory. On examination, he also has ataxia, nystagmus and mild pedal oedema. He is admitted for investigation where the nurses notice he is confabulating and smells faintly of fish.

 

2. A 38-year-old dog enthusiast from Battersea presents with dyspepsia and shortness of breath on exercise (walking the dog). Blood tests show a severe anaemia, which on investigation is found to be megaloblastic. Gastric biopsies taken at endoscopy show severe atrophic gastritis, predominantly in the corpus. Anti-parietal cell antibodies are detected in the serum

 

3. A 52-year-old man, who just happens to be related to lizo off newsround, suffers from longstanding chronic pancreatitis. This has lead to steatorrhoea. He presents with recurrent epistaxis, malaena and haematuria. On examination he also has numerous bruises on his arms and shins.

 

4. An eighty-year-old woman lives alone, loves Cliff Richard and smells a bit like cats. She is visited by social services after a worried neighbour, also a fan of Sir Cliff, says she has not seen her for a few months. On questioning she admits that she has hardly left her flat for four months as she has become increasingly agoraphobic. She has been surviving on tinned soup and crackers. Her GP hates Cliff Richard but calls to examine her anyway and finds she has swollen, bleeding gums, and bruises over her shins. Her skin shows a hyperkeratotic popular rash and petechial haemorrhages.

 

5. A 3-year-old Indian boy whose parents are strict vegans, drive a flowery VW camper van and who obviously can’t get over the fact that the sixties are over, is taken to his GP with a cough. On examination of his chest, he is found to have anterior protusion of the sternum. The GP also notices that he has lumbar lordosis and bowing of the legs.

 

 

ANSWERS

1. D

2. F

3. J

4. G

5. H