NEET-PG 2025 — General Medicine

Q: A patient on long-term hydrochlorothiazide therapy presents with features of neuropathy, heart failure, and symmetrical tingling sensations. Which of the following nutrient deficiencies is most likely responsible?

Thiamine. Thiamine - The combination of **neuropathy** (symmetrical tingling sensations) and **heart failure** (cardiomyopathy) is the classic manifestation of **Beriberi**, caused by Thiamine (Vitamin B1) deficiency [1]. - **Wet Beriberi** causes high-output **cardiac failure**, while **Dry Beriberi** is responsible for **symmetrical peripheral neuropathy** [1]. *Selenium* - Selenium deficiency causes **Keshan disease**, which is characterized by **cardiomyopathy**, but the simultaneous presentation of specific symmetrical peripheral neuropathy is less common. - Deficiency can also lead to muscle pain and weakness, but often does not perfectly match this triad. *Vitamin B12* - Deficiency causes **Subacute Combined Degeneration** (neuropathy and myelopathy) and **megaloblastic anemia**, but severe acute heart failure is not a defining feature. - Neuropathy typically involves a mix of sensory, motor, and central nervous system signs, but the heart failure component is missing. *Zinc* - Zinc deficiency primarily causes **acrodermatitis enteropathica** (dermatitis), impaired wound healing, and immune dysfunction. - It is not a common cause of either **heart failure** or widespread peripheral neuropathy. [Practice more General Medicine PYQs on OnCourse]

1 Previous Year Questions with Answers & Explanations

Questions

A patient on long-term hydrochlorothiazide therapy presents with features of neuropathy, heart failure, and symmetrical tingling sensations. Which of the following nutrient deficiencies is most likely responsible?