Mineral deficiency disorders — MCQs

A 37-year-old man is brought to the emergency department because he was found down on a city sidewalk. Upon presentation he is found to be disheveled with multiple poorly healed wounds on his hands and feet. He has had dozens of previous presentations for alcohol intoxication and is currently known to be homeless. Physical examination reveals multiple minor wounds, alopecia, and decreased axillary hair. Upon being aroused, the patient reveals that he has had difficulty with taste and smell and has also had severe diarrhea over the last week. The deficient substance most likely responsible for this patient's symptoms is associated with which of the following proteins?

An investigator is studying a drug that acts on the thyroid hormone pathway. Levels of serum free T3 and T4 in healthy participants are measured before and after administration of the drug. After administration, there is a decrease in the average serum free T3 level, while the average serum free T4 level is increased compared to initial serum studies. Inhibition of which of the following is the most likely mechanism of action of this drug?

A 57-year-old woman comes to the physician because of a 3-month history of easy fatigability and dyspnea on exertion. Menopause occurred 5 years ago. Her pulse is 105/min and blood pressure is 100/70 mm Hg. Physical examination shows pallor of the nail beds and conjunctivae. A peripheral blood smear shows small, pale red blood cells. Further evaluation is most likely to show which of the following findings?

A 52-year-old male presents to clinic with complaints of anxiety and fatigue for 4 months. He has also been experiencing palpitations, muscle weakness, increased sweating, and an increase in the frequency of defecation. Past medical history is insignificant. He neither consumes alcohol nor smokes cigarettes. His pulse is 104/min and irregular, blood pressure is 140/80 mm Hg. On examination, you notice that he has bilateral exophthalmos. There are fine tremors in both hands. Which of the following results would you expect to see on a thyroid panel?

A homeless woman presents with shortness of breath on exertion and pedal edema. Cardiac workup performed shows evidence of dilated cardiomyopathy and increased cardiac output. She also has decreased sensation over both extremities bilaterally. Which vitamin deficiency most likely caused these symptoms?

A 6-month-old boy presents with decreased growth, pigmented retinopathy, hemolytic anemia, and peripheral neuropathy. You suspect that these signs are the result of a vitamin deficiency leading to increased oxidative damage to lipids. Which of the following is most likely responsible for this patient's symptoms?

A 23-year-old woman presents to her primary care physician due to amenorrhea. The patient states that historically she has her period once every three months but recently has not had it at all. Otherwise, she has no other complaints. The patient recently started college and is a varsity athlete for the track team. She works part time in a coffee shop and is doing well in school. The patient is not sexually active and does not drink alcohol, use illicit drugs, or smoke. She has no significant past medical history and occasionally takes ibuprofen for headaches. Her temperature is 99.5°F (37.5°C), blood pressure is 100/55 mmHg, pulse is 50/min, respirations are 10/min, and oxygen saturation is 98% on room air. On physical exam, you note a young, lean, muscular woman in no acute distress. Which of the following is the most likely long-term outcome in this patient?

The parents of a newly adopted 5-year-old child brought him to the pediatrician after he started to have bouts of diarrhea and bloating. His symptoms are worse after consuming dairy products and ice cream. The immunization history is up to date. His height and weight are in the 60th and 70th percentiles, respectively. His physical examination is normal. The pediatrician orders some lab tests because she believes there is a biochemical disorder. What is the first-line therapy for the most likely condition?

A 17-year-old girl presents to her primary care physician for a wellness checkup. The patient is currently doing well in school and plays soccer. She has a past medical history of childhood obesity that was treated with diet and exercise. The patient states that her menses have not changed, and they occur every 1 to 3 months. Her temperature is 99.5°F (37.5°C), blood pressure is 127/70 mmHg, pulse is 90/min, respirations are 13/min, and oxygen saturation is 98% on room air. The patient's BMI at this visit is 22.1 kg/m^2. On physical exam, the patient is in no distress. You note acne present on her face, shoulders, and chest. You also note thick, black hair on her upper lip and chest. The patient's laboratory values are seen as below. Hemoglobin: 14 g/dL Hematocrit: 42% Leukocyte count: 7,500/mm^3 with normal differential Platelet count: 177,000/mm^3 Serum: Na+: 137 mEq/L Cl-: 101 mEq/L K+: 4.4 mEq/L HCO3-: 24 mEq/L BUN: 27 mg/dL Glucose: 90 mg/dL Creatinine: 1.0 mg/dL Ca2+: 10.1 mg/dL Testosterone: 82 ng/dL 17-hydroxyprogesterone: elevated AST: 12 U/L ALT: 10 U/L Which of the following is associated with this patient's most likely diagnosis?

A 60-year-old man is brought to the emergency department by police officers because he was seen acting strangely in public. The patient was found talking nonsensically to the characters on cereal boxes in a grocery store. Past medical history is significant for multiple hospitalizations for alcohol-related injuries and alcohol withdrawal seizures. Vital signs are within normal limits. On physical examination, the patient is disheveled and oriented x1. Neurologic examination shows horizontal nystagmus and severe ataxia. It is noted that after interviewing the patient, he forgets the faces of persons and the questions asked shortly after he walks out the door. He, however, remembers events from his distant past quite well. Which of the following is the most likely diagnosis in this patient?