NBME 4 Form 3 Q 10 - hrani1130

[ArchivalUser]

A 65 year old woman with 25 year history of chronic alcoholism is brought to the emergency department because she is vomiting blood. she eats little more than an occasional sandwich. examination of the mouth shows loosening of the teeth. There is perifollicular hyperkeratosis, purpura, ecchymoses, and hemorrhage of the lower extremities. The most lilkely cause of these symptoms is a deficiency of which of the following nutrients?

A. Folic acid
B. Iron
C. Niacin
D. Protein
E. Vitamin A
F. Vitamin B6
G. Vitamin C
H. Vitamin E
I. Vitamin K

Please explain your choice as I am debating between to answer choices.

I think it is either G and I.

Vitamin K seems more likely to me as the patient is a chronic alcoholic and is vomiting blood (possibly Esophageal varices). Assuming that the patient has liver cirrhosis then she is Vit K deficient. Question also mentions hemorrhage in lower extremities. But all the other signs point to Vit C deficiency (perifollicular hyperkeratosis, purpura, ecchymoses etc)

[ArchivalUser]

its g according to the clinical findings.... n vit k.. see the history too... vit k cant be....

[ArchivalUser]

it is vit C deficiency because there are symptoms specific for vit C deficiency :

perifollicular hyperkeratosis and loosening of teeth