Vitamin Deficiencies — MCQs
Which of the following is NOT a manifestation of vitamin E deficiency?
A patient presents with symptoms of dermatitis, dementia, and cognitive decline. Which micronutrient deficiency is most likely responsible?
A patient on a maize diet presented with diarrhea, dementia and dermatitis. Which vitamin deficiency is responsible for these features
A 30-year-old highly health conscious woman has been ingesting vitamins and health foods. She is complaining of hair loss, double vision and headache. Her liver function tests are abnormal. She may be suffering from
Which vitamin deficiency is associated with night blindness and impaired immunity?
Wernicke's encephalopathy is due to deficiency of:
Vitamin K supplementation is given to neonates to prevent _____ .
A 69-year-old edentulous alcoholic male who lives alone is admitted to the hospital for evaluation of a shoulder wound that is not healing well. On physical examination, numerous ecchymoses are noted on the posterior aspect of his legs and thighs. Careful examination of the man's skin reveals minute hemorrhages around hair follicles and splinter hemorrhages in the nail beds. Laboratory examination is remarkable for a hemoglobin of 10 g/dL (normal 14-18 g/dL); no other hematologic abnormalities are noted. Therapy should consist of what?
Which vitamin deficiency is most commonly associated with rickets in children?
A 2-year-old child with a history of eczema presents with a red, scaly rash around the mouth and extremities. A dietary history reveals excessive consumption of cow's milk. What nutritional deficiency is most likely?
Vitamin Deficiencies Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is NOT a manifestation of vitamin E deficiency?
- A. Posterior column abnormalities
- B. Cerebellar ataxia
- C. Hemolytic anemia
- D. Autonomic dysfunction (Correct Answer)
Explanation: ***Autonomic dysfunction*** - **Autonomic dysfunction** is not typically associated with vitamin E deficiency. Instead, it is commonly seen in conditions like **diabetes mellitus**, Parkinson's disease, or certain inherited neuropathies. - Vitamin E primarily acts as an **antioxidant** and is crucial for neurological and red blood cell health. *Hemolytic anemia* - Vitamin E is an **antioxidant** that protects red blood cell membranes from **oxidative damage**. - Its deficiency can lead to increased fragility and **hemolysis** of red blood cells, resulting in hemolytic anemia, particularly in premature infants. *Posterior column abnormalities* - Vitamin E deficiency can cause **neurological dysfunction** due to oxidative damage to neuronal membranes. - This often manifests as degeneration of the **posterior columns** of the spinal cord, leading to impaired proprioception and vibratory sensation. *Cerebellar ataxia* - The **cerebellum** is highly susceptible to oxidative stress, and vitamin E deficiency can lead to damage in this area. - This damage results in **ataxia**, characterized by impaired coordination, balance, and gait disturbances.
Question 2: A patient presents with symptoms of dermatitis, dementia, and cognitive decline. Which micronutrient deficiency is most likely responsible?
- A. Niacin (Correct Answer)
- B. Thiamine
- C. Tryptophan
- D. Retinol
- E. Riboflavin
Explanation: ***Niacin*** - The classic triad of symptoms known as the "3 Ds"—**dermatitis, dementia, and diarrhea**—is characteristic of **pellagra**, a severe deficiency of **niacin (vitamin B3)**. - **Cognitive decline** is a common manifestation of the neurological symptoms associated with dementia in pellagra. *Thiamine* - **Thiamine (vitamin B1)** deficiency causes **beriberi**, leading to cardiovascular (wet beriberi) or neurological (dry beriberi/Wernicke-Korsakoff syndrome) symptoms. - While **fatigue and cognitive impairment** can occur, the constellation of prominent dermatitis and severe dementia is not typical of primary thiamine deficiency. *Tryptophan* - **Tryptophan** is an **essential amino acid** and a precursor to niacin. A deficiency in tryptophan could indirectly lead to niacin deficiency. - However, the direct deficiency of tryptophan as the primary cause of the "3 Ds" is less common than a direct niacin deficiency or impaired niacin synthesis. *Retinol* - **Retinol (vitamin A)** deficiency primarily affects **vision**, leading to **night blindness** and xerophthalmia. - It also plays a role in immune function and epithelial cell integrity, but it does not cause the specific triad of dermatitis, dementia, and cognitive decline seen here. *Riboflavin* - **Riboflavin (vitamin B2)** deficiency causes **angular stomatitis, cheilosis, and glossitis** along with seborrheic dermatitis. - While it can cause skin manifestations, it does not typically present with the severe dementia and cognitive decline characteristic of pellagra.
Question 3: A patient on a maize diet presented with diarrhea, dementia and dermatitis. Which vitamin deficiency is responsible for these features
- A. Niacin (Correct Answer)
- B. Riboflavin
- C. Thiamine
- D. Pyridoxine
- E. Cobalamin
Explanation: ***Niacin*** - The classic presentation of **pellagra**, caused by a deficiency of **niacin (Vitamin B3)**, is characterized by the "**3 Ds**": **dermatitis**, **diarrhea**, and **dementia**. In severe cases, a fourth 'D' for death can also occur. - A **maize (corn)** staple diet is a known risk factor for niacin deficiency because maize contains niacin in a bound, non-bioavailable form (niacytin) and is low in tryptophan, a precursor to niacin. *Riboflavin* - **Riboflavin (Vitamin B2)** deficiency leads to **ariboflavinosis**, which can cause **cheilosis**, **angular stomatitis**, **glossitis**, and **seborrheic dermatitis**, but not the constellation of diarrhea, dementia, and dermatitis seen in pellagra. - It does not typically manifest with neurological or gastrointestinal symptoms as severe as those described in the question. *Thiamine* - **Thiamine (Vitamin B1)** deficiency causes **beriberi**, characterized by **neurological (dry beriberi)** or **cardiovascular (wet beriberi)** symptoms. - It can lead to **Wernicke-Korsakoff syndrome** in severe cases, which includes neurological deficits, but not the specific "3 Ds" of pellagra. *Pyridoxine* - **Pyridoxine (Vitamin B6)** deficiency can cause **neurological symptoms** such as **peripheral neuropathy**, **seizures**, and **depression**, as well as **dermatitis** and **glossitis**. - It does not present with the characteristic triad of dermatitis, diarrhea, and dementia seen in pellagra. *Cobalamin* - **Cobalamin (Vitamin B12)** deficiency causes **megaloblastic anemia** and **neurological symptoms** including **subacute combined degeneration** of the spinal cord, **peripheral neuropathy**, and **cognitive changes**. - While it can cause neurological symptoms, it does not present with the classic dermatitis and diarrhea combination seen in pellagra.
Question 4: A 30-year-old highly health conscious woman has been ingesting vitamins and health foods. She is complaining of hair loss, double vision and headache. Her liver function tests are abnormal. She may be suffering from
- A. Vitamin E deficiency
- B. Hypervitaminosis D
- C. Hypervitaminosis A (Correct Answer)
- D. Vitamin C deficiency
Explanation: ***Hypervitaminosis A*** - Chronic intake of excessive amounts of **vitamin A** can lead to symptoms such as **hair loss**, **double vision (diplopia)**, and **headache**. - **Liver function abnormalities** are a common feature of hypervitaminosis A due to the liver's role in vitamin A storage and metabolism. *vitamin E deficiency* - **Vitamin E deficiency** typically manifests with neurological symptoms like **ataxia**, **peripheral neuropathy**, and **muscle weakness**, given its role as an antioxidant. - It is not associated with the constellation of symptoms presented, especially **hair loss**, **double vision**, **headache**, and **liver dysfunction**. *Hypervitaminosis D* - **Hypervitaminosis D** primarily leads to **hypercalcemia**, presenting with symptoms such as **nausea**, **vomiting**, **polyuria**, and **kidney stones**. - It does not typically cause **hair loss**, **double vision**, or direct effects on **liver function** in the way described. *Vitamin C deficiency* - **Vitamin C deficiency** (scurvy) is characterized by symptoms like **gingival bleeding**, **petechiae**, **poor wound healing**, and **fatigue**. - These symptoms are distinctly different from the **neurological and hepatic manifestations** seen in the patient.
Question 5: Which vitamin deficiency is associated with night blindness and impaired immunity?
- A. Vitamin K
- B. Vitamin C
- C. Vitamin D
- D. Vitamin A (Correct Answer)
Explanation: ***Vitamin A*** - **Vitamin A deficiency** is a classic cause of **night blindness** (nyctalopia) due to its role in the formation of **rhodopsin**, a light-sensitive pigment in the retina. - It also plays a crucial role in maintaining **immune function**, particularly in the integrity of epithelial tissues and normal lymphocyte activity. *Vitamin K* - **Vitamin K** is primarily involved in **blood clotting** (coagulation) through its role in the synthesis of clotting factors. - Deficiency leads to **bleeding disorders** and has no direct association with night blindness or significant impaired immunity. *Vitamin C* - **Vitamin C** (ascorbic acid) is essential for **collagen synthesis**, acting as an antioxidant and playing a role in immune defense. - Severe deficiency causes **scurvy**, characterized by bleeding gums, poor wound healing, and fatigue, but not night blindness. *Vitamin D* - **Vitamin D** is crucial for **calcium and phosphate metabolism**, bone health, and immune regulation. - Deficiency can lead to **rickets** in children and **osteomalacia** in adults, and while it impacts immunity, it does not cause night blindness.
Question 6: Wernicke's encephalopathy is due to deficiency of:
- A. B6
- B. Thiamine (Correct Answer)
- C. B12
- D. Niacin
Explanation: ***Thiamine*** - **Wernicke's encephalopathy** is a serious neurological disorder directly caused by a severe deficiency of **thiamine (vitamin B1)**. - Thiamine is crucial for **glucose metabolism** in the brain; its deficiency impairs energy production, leading to neuronal damage and the characteristic symptoms of confusion, ataxia, and ophthalmoplegia. *B6* - Deficiency of **vitamin B6 (pyridoxine)** can cause peripheral neuropathy, seizures, and microcytic anemia. - It is not the primary cause of the acute neurological syndrome seen in Wernicke's encephalopathy. *B12* - Deficiency of **vitamin B12 (cobalamin)** is associated with megaloblastic anemia and subacute combined degeneration of the spinal cord. - While it can cause neurological symptoms, they differ from the specific triad of Wernicke's encephalopathy. *Niacin* - Deficiency of **niacin (vitamin B3)** causes **pellagra**, characterized by dermatitis, diarrhea, and dementia. - Although it involves neurological symptoms (dementia), the presentation is distinct from Wernicke's encephalopathy.
Question 7: Vitamin K supplementation is given to neonates to prevent _____ .
- A. Hemorrhagic disease of the newborn (Correct Answer)
- B. Scurvy
- C. Keratomalacia
- D. Breast milk jaundice
- E. Rickets
Explanation: ***Hemorrhagic disease of the newborn*** - Neonates have low levels of **vitamin K-dependent clotting factors** (II, VII, IX, X) due to poor placental transfer, sterile gut, and low vitamin K in breast milk. - Vitamin K supplementation at birth prevents potentially life-threatening bleeding episodes, known as **hemorrhagic disease of the newborn (VKDB)**, by ensuring adequate clotting factor production. *Scurvy* - Scurvy is caused by **vitamin C deficiency**, leading to impaired collagen synthesis. - Symptoms include **gingival bleeding**, skin hemorrhages, and poor wound healing, which are distinct from vitamin K deficiency. *Keratomalacia* - Keratomalacia is a severe eye condition resulting from **vitamin A deficiency**, characterized by drying and clouding of the cornea. - It leads to **blindness** and is not related to vitamin K metabolism. *Breast milk jaundice* - Breast milk jaundice is a common and usually benign condition in neonates where **breast milk components** interfere with bilirubin metabolism, prolonging physiological jaundice. - It is not prevented by vitamin K and is entirely distinct from coagulation disorders. *Rickets* - Rickets is caused by **vitamin D deficiency**, resulting in defective bone mineralization and skeletal deformities. - Clinical features include **bowed legs**, rachitic rosary, and delayed fontanelle closure, which are unrelated to coagulation or vitamin K.
Question 8: A 69-year-old edentulous alcoholic male who lives alone is admitted to the hospital for evaluation of a shoulder wound that is not healing well. On physical examination, numerous ecchymoses are noted on the posterior aspect of his legs and thighs. Careful examination of the man's skin reveals minute hemorrhages around hair follicles and splinter hemorrhages in the nail beds. Laboratory examination is remarkable for a hemoglobin of 10 g/dL (normal 14-18 g/dL); no other hematologic abnormalities are noted. Therapy should consist of what?
- A. Administration of vitamin C (Correct Answer)
- B. Administration of factor IX
- C. Administration of folic acid
- D. Administration of vitamin D
Explanation: The patient's presentation with **poor wound healing**, **ecchymoses**, **perifollicular hemorrhages**, and **splinter hemorrhages**, in an **edentulous alcoholic male** (indicating poor nutrition), are classic signs and symptoms of **scurvy** caused by **vitamin C deficiency** [1]. **Vitamin C (ascorbic acid)** is essential for **collagen synthesis** (wound healing, blood vessel integrity) and iron absorption, explaining the observed symptoms [1]. A dose of 250 mg vitamin C 3 times daily by mouth should saturate the tissues quickly [1].
Question 9: Which vitamin deficiency is most commonly associated with rickets in children?
- A. Vitamin A
- B. Vitamin C
- C. Vitamin D (Correct Answer)
- D. Vitamin K
Explanation: ***Vitamin D*** - **Vitamin D** plays a crucial role in the absorption of **calcium** and **phosphate**, which are essential for proper **bone mineralization**. - A deficiency leads to impaired mineralization of newly formed bone matrix, resulting in soft, weak bones characteristic of **rickets** in children and **osteomalacia** in adults. *Vitamin A* - **Vitamin A** is primarily involved in **vision**, immune function, and cell growth and differentiation. - While essential for health, its deficiency is not directly linked to the skeletal deformities seen in rickets. *Vitamin C* - **Vitamin C** is vital for **collagen synthesis**, a key component of connective tissues, skin, and bone matrix. - Its deficiency causes **scurvy**, characterized by bleeding gums, poor wound healing, and joint pain, not the bone deformities of rickets. *Vitamin K* - **Vitamin K** is essential for **blood coagulation** and plays a role in bone metabolism through the carboxylation of certain bone proteins like **osteocalcin**. - However, its deficiency primarily leads to bleeding disorders and does not cause rickets.
Question 10: A 2-year-old child with a history of eczema presents with a red, scaly rash around the mouth and extremities. A dietary history reveals excessive consumption of cow's milk. What nutritional deficiency is most likely?
- A. Zinc deficiency (Correct Answer)
- B. Iron deficiency
- C. Vitamin D deficiency
- D. Vitamin C deficiency
Explanation: ***Zinc deficiency*** - The combination of **eczema**, perioral and acral **dermatitis** (red, scaly rash around the mouth and extremities), and a diet rich in **cow's milk** in a 2-year-old strongly points to zinc deficiency. - Cow's milk can inhibit **zinc absorption**, and infants with eczema may have increased zinc demands or impaired absorption. *Iron deficiency* - While common in toddlers, especially with high cow's milk intake, **iron deficiency** primarily manifests as **anemia**, pallor, and fatigue, not a characteristic rash. - It does not typically cause the specific **dermatitis** described. *Vitamin D deficiency* - Primarily linked to **rickets** in children, causing bone deformities and growth delays. - Does not present with a **red, scaly rash** around the mouth and extremities. *Vitamin C deficiency* - Leads to **scurvy**, characterized by swollen, bleeding gums, perifollicular hemorrhages, and poor wound healing. - The described **dermatological symptoms** are not typical of vitamin C deficiency.
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