Water-soluble vitamins - B complex — MCQs

A 48-year-old woman is brought to the emergency department by police because of confusion and agitation. Her medical record indicates that she has peptic ulcer disease that is treated with omeprazole. The patient's brother arrives shortly after. He reports that she drinks around 17 oz. of vodka daily. Neurological examination shows horizontal nystagmus. Her gait is wide-based with small steps. Her hemoglobin concentration is 9.1 g/dL. A peripheral blood smear shows hypersegmented neutrophils. Homocysteine levels are elevated. Methylmalonic acid levels are within normal limits. Which of the following is the most likely direct cause of this patient's anemia?

A 34-year-old man presents with dysphagia. The patient says that he has pain on swallowing which gradually onset 2 weeks ago and has not improved. He denies any change in diet but does say that he recently returned from a prolonged work trip to the Caribbean. No significant past medical history or current medications. On physical examination, the patient looks pale. His tongue is swollen and has a beefy, red appearance. Angular stomatitis is present. Laboratory findings are significant for macrocytic, megaloblastic anemia, decreased serum folate, increased serum homocysteine, and normal methylmalonic acid levels. Which of the following conditions most likely caused this patient’s symptoms?

A 35-year-old alcoholic patient presents with high-output cardiac failure, tachycardia, a bounding pulse, and warm extremities. Blood work reveals vitamin deficiency. Which of the following vitamin deficiencies is most likely associated with such a clinical presentation?

A 24-year-old man presents to the emergency department complaining of a prolonged course of diarrhea. He reports that he has had 3–4 large volume watery stools daily for the last several weeks. He has no pain with bowel movements, no abdominal pain, and no blood in his stools. He is homeless and uses recreational drugs. He also reports that he usually drinks a half-liter of whiskey, or whatever else he can find, every day and he has done this for several years. The physical exam is notable for a hyperpigmented rash across his face, neck, chest, and the backs of his hands and forearms. On mental status exam, he is oriented to person and place but not time; he scores a 23/30 on the Montreal Cognitive Assessment (MOCA). This patient's presentation is most likely related to which of the following micronutrients?

A 51-year-old gentleman presents with new onset bilateral paresthesias of his feet. He also admits that he has not been able to exercise as much as previously and his friends have commented that he looks pale. Upon physical exam you find that he has conjunctival pallor and mildly decreased sensation and proprioception on his feet bilaterally. Based on your suspicions you decide to obtain a blood smear where you see megaloblasts as well as hypersegmented neutrophils. Given these findings you decide to investigate the cause of his disorder by injecting an intramuscular vitamin, then feeding him a radiolabeled version of the same vitamin orally. After waiting 24 hours you see that no radiolabeled vitamin appears in the urine so you repeat the test with intrinsic factor added to the oral mixture, at which point 20% of the radiolabeled vitamin appears in the urine. Which of the following is the most likely etiology of this gentleman's symptoms?

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 17-year-old high school student presents to your office for recent mood and skin changes. The patient is a high school senior who is competing on the wrestling team and recently has lost weight to drop two weight classes over the past several months. He states he has dry, cracking, and irritated skin, as well as a sensation of tingling in his hands and feet. The patient also states that he has not been feeling himself lately. He finds himself more irritable and no longer enjoys many of the activities he once enjoyed. He finds that he often feels fatigued and has trouble concentrating. The patient does not have a significant past medical history and is not on any current medications. The patient admits to drinking alcohol and smoking marijuana on special occasions. He states that he uses supplements that his other team members use. Physical exam is significant for acne, dry, cracked skin around the patient's mouth in particular, and decreased sensation in his lower extremities. Laboratory values are as follows: Serum: Na+: 137 mEq/L Cl-: 101 mEq/L K+: 4.1 mEq/L HCO3-: 24 mEq/L BUN: 15 mg/dL Glucose: 79 mg/dL Creatinine: 0.9 mg/dL Ca2+: 9.2 mg/dL Mg2+: 1.5 mEq/L Homocysteine: 11.2 µmol/L (normal: 4.6 to 8.1 µmol/L) AST: 11 U/L ALT: 11 U/L Alkaline phosphatase: 27 U/L Albumin: 4.5 g/dL Total protein: 6.9 g/dL Total bilirubin: 0.5 mg/dL Direct bilirubin: 0.3 mg/dL Which of the following is the most likely diagnosis?

A 66-year-old male with a history of deep venous thrombosis is admitted to the hospital with shortness of breath and pleuritic chest pain. He is treated with an anticoagulant, but he develops significant hematochezia. His BP is now 105/60 and HR is 117; both were within normal limits on admission. The effects of the anticoagulant are virtually completely reversed with the administration of protamine. Which of the following was the anticoagulant most likely administered to this patient?

A 42-year-old man presents to his primary care provider with recent swelling in his legs that has now spread to the lower part of his thighs. He sometimes has difficulty putting on his shoes and pants. He also noticed puffiness under his eyes over the last 3 weeks. A 24-hour urine collection confirms proteinuria of 5 g/day. Electron microscopy of a renal biopsy specimen reveals subepithelial deposits with a spike and dome pattern. Which of the following is associated with this patient’s condition?

A 3-year-old boy is brought to the physician for a follow-up examination. He has lactose intolerance. His family emigrated from Somalia 6 months ago. He is at the 30th percentile for height and 15th percentile for weight. Vital signs are within normal limits. Examination shows pale conjunctivae, an erythematous throat, and swollen tongue. There is inflammation of the perioral and labial mucosa, and peeling and cracking of the skin at the corners of the mouth. Cardiopulmonary examination shows no abnormalities. His hemoglobin concentration is 9.8 g/dL and mean corpuscular volume is 87 μm3. If left untreated, this child is also most likely to develop which of the following?