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NBME 22 Answers

nbme22/Block 4/Question#8

A 6-year-old boy who recently emigrated from Russia ...

Vitamin E

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 +4  upvote downvote
submitted by someduck3(33),

Fat soluble vitamins are A,D,E,K. So both D & E could be decreased in this pt. But you have to know that Vitamin E deficiency is associated with demyelination & has been associated with posterior column demyelination. Also Vit E can be given with Alzheimer patients as it helps with free radicals..?

aesalmon  I actually thought that the posterior column findings were likely due to B12 deficiency - "subactue combined degeneration", due to malabsorption, as we see in this pt (. Turns out vitamin E can also cause symptoms which look like subacute combined degeneration: https://www.ncbi.nlm.nih.gov/pubmed/9012278, as does Copper (TIL): https://www.ncbi.nlm.nih.gov/pubmed/15249607 +3  
jooceman739  Vitamin E deficiency causes posterior column findings and hemolytic anemia :) +3  
nwinkelmann  The way I think about it is that essentially, vitamin E is an anti-oxidant. Vitamin E deficiency = LOTS of oxidation, i.e. free radicals, which are toxic to most cells in the body (particularly myelination and RBCs). That's why it can be used with Alzheimer's patients. +3  
makinallkindzofgainz  Vitamin E presents like B12 deficiency but without megaloblastic anemia +  

 +1  upvote downvote
submitted by alexb(31),

I think there's a UWorld question describing how cystic fibrosis can cause fat soluble vitamin deficiency and how a Vit E def in that context might manifest similarly to B12 def. (Also in first aid)

 +0  upvote downvote
submitted by dentist(17),

Ataxia due to vitamin deficiency can only be caused by Thiamine or Vitamin E deficiency.