NBME 22 Vitamin E (NBME Answers)

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Retired NBME 22 Answers

nbme22/Block 4/Question#8 (reveal difficulty score)
A 6-year-old boy who recently emigrated from ...
Vitamin E 🔍 / 📺 / 🌳 / 📖
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submitted by ∗someduck3(66)

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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..?

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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 :) +6

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. +4

makinallkindzofgainz Vitamin E presents like B12 deficiency but without megaloblastic anemia +1

kevin B12 would also affect lateral corticospinal tracts, vit E doesn't to my knowledge (b12 deficiency would also present with hyperreflexia but E deficiency just romberg sign, loss of proprioception and touch, ataxia) +

abhishek021196 This Divine Intervention podcast mentions this very clearly - https://divineinterventionpodcasts.com/2019/10/12/divine-intervention-episode-168-usmle-step-1-rapid-review-series-11-integrated/ +

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submitted by ∗alexb(53)

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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)

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madamestep Looks like B12 but no megaloblastic anemia = Vitamin E +

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submitted by ∗dentist(94)

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

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