07-10-2008, 04:20 AM
A 15-year-old boy is brought into your office by his parents because of numbness and tingling in his
feet, slowly increasing over the last several weeks. He has attention deficit hyperactivity disorder for
which he has been taking methylphenidate for the past 4 years. In addition, he had a positive PPD skin
test after screening upon entrance to high school and was placed on isoniazid 6 months ago. He takes
no other medications and has no allergies. His parents feel that he has become more difficult to control
since entering high school and the father confides to you that he suspects these "latest complaints" are
a method of avoiding physical education class. He answers your questions readily and reports that gym
is actually his favorite class at school. He denies any problems at home, with friends, or at school. On
physical examination, you find nothing abnormal except hyperesthesia over a stocking distribution of
both lower extremities. Deep tendon reflexes, motor function, and sensation are intact. This patient's
current condition would have most likely been prevented by supplementation with
A. folate
B. pyridoxine
C. riboflavin
D. thiamine
E. vitamin E
feet, slowly increasing over the last several weeks. He has attention deficit hyperactivity disorder for
which he has been taking methylphenidate for the past 4 years. In addition, he had a positive PPD skin
test after screening upon entrance to high school and was placed on isoniazid 6 months ago. He takes
no other medications and has no allergies. His parents feel that he has become more difficult to control
since entering high school and the father confides to you that he suspects these "latest complaints" are
a method of avoiding physical education class. He answers your questions readily and reports that gym
is actually his favorite class at school. He denies any problems at home, with friends, or at school. On
physical examination, you find nothing abnormal except hyperesthesia over a stocking distribution of
both lower extremities. Deep tendon reflexes, motor function, and sensation are intact. This patient's
current condition would have most likely been prevented by supplementation with
A. folate
B. pyridoxine
C. riboflavin
D. thiamine
E. vitamin E