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NBME 20 Answers

nbme20/Block 4/Question#37 (30.3 difficulty score)
A 16-year-old girl with cystic fibrosis is ...
Vitamin E🔍,📺

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submitted by dickass(103),
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AF pg 7:0

iVt E iec:dnieyfc

cloiNurgoe ensntoatprei yam rppaea amirlsi ot itainmv 21B ifecec,dniy btu whittuo algabimtcosel man,aei etedresghymnpe itsonhrleup, or  eurms noatihllemcmy idca lelsv.e

dickass  and VitB12 neurologic symptoms are described on pg 518 +  

submitted by jackie_chan(28),

Cystic fibrosis patient --> consider fat soluble vitamin deficiencies Presentation is neurologic with ataxia, mostly likely Vit E

A deficiency- visual, infections D- calcium low K- bleeding, coagulopathy

Folic acid- anemia, not given B6- anemia also (heme synthesis defect/ALA synthase)

submitted by usmleuser007(419),
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tiiVmna E incyeefcid si nowkn ot esacu slmiira nasilp tsdfeec as aVimtni 1B2 f.yecinidce wr,voeHe anieam is nto e.esn

ergogenic22  Also corticalspinal tract symptoms are not seen, but dorsal column and spinocerebellar tracts are seen +4  
sinforslide  In this case, patient's CF also predisposes fat-soluble vitamin deficiency. +9  
breis  FA pg 70 +  
usmleuser007  Correction: Read more on this Vitamin-E deficiency can in fact cause anemia - hemolytic anemia. This is b/c VitE work as an anti-oxidant; and therefore with reduced anti-oxidation RBCs are more prone to oxidative injuries. +4  
azharhu786  AMBOSS: Hemolytic anemia; increased fragility of erythrocytes and membrane breakdown are also caused by vitamin E. +1