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+--- Thread: nbme2,3,38 - javid (/showthread.php?tid=585476)
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nbme2,3,38 - javid - ArchivalUser - 05-11-2011
38. A 66-year-old man has had numbness and tingling
in the hands and
feet for 2 weeks. He lives in a homeless shelter and
is well fed. He
has been treated for pulmonary tuberculosis for 4
months with
isoniazid, rifampin, ethambutol, and pyrazinamide. He
is compliant with his
medication regimen but continues to abuse alcohol.
His temperature is 37
C (98.6 F), blood pressure is 136/76 mm Hg, pulse is
72/min, and
respirations are 20/min. He is well nourished but
depressed and irritable.
There is decreased sensation to pain and touch in the
hands and feet in
a stocking-glove distribution. Which of the following
is the most
likely nutritional deficiency?
A
) Folic acid
B
) Niacin
C
) Vitamin A
D
) Vitamin B1 (thiamine)
E
) Vitamin B2 (riboflavin)
F
) Vitamin B6
G
) Vitamin B12 (cyanocobalamin)
H
) Vitamin C
I
) Vitamin D
J
) Vitamin E
K
) Vitamin K
0 - ArchivalUser - 05-12-2011
f...Peripheral neuropathy and CNS effects are associated with the use of isoniazid and are due to pyridoxine (vitamin B6) depletion, but are uncommon at doses of 5 mg/kg. Persons with conditions in which neuropathy is common (e.g., diabetes, uremia, alcoholism, malnutrition, HIV-infection), as well as pregnant women and persons with a seizure disorder, may be given pyridoxine (vitamin B6) (10–50 mg/day) with isoniazid.
http://en.wikipedia.org/wiki/Isoniazid
0 - ArchivalUser - 05-12-2011
I chose F too,but the answer was Thiamin,how do you R/O thiamin?
0 - ArchivalUser - 05-12-2011
I think it's B6 deficiency.
The q said "He lives in a homeless shelter and is well fed...he is well-nourished"...B1 defi in alcoholics may be due to reduced dietary intake typically found in alcoholics. But he is well-fed in the shelter.
We all know that INH should be administered with B6.
So, this q is pointing toward B6 in my opinion.
0 - ArchivalUser - 05-12-2011
that answer key is wrong...
use this key:
http://www.usmleforum.com/showthread.php?tid=547666
0 - ArchivalUser - 05-12-2011
why he is DEPRESSED AND IRRITABLE ? is it higher brain or cortical function involvement seen in B1 deficiency ?
will we be able to see this finding in B6 DEFICIENCY ?
0 - ArchivalUser - 05-12-2011
plz any one have step2 ck NBME forum offline form?
plz send these to me at athwanivicky
0 - ArchivalUser - 05-13-2011
thank you goforward
0 - ArchivalUser - 05-14-2011
The signs and symptoms of a deficient amount of vitamin B6 in the body can be all over the map, really. However, some people that suffer from this condition have symptoms like:
Insomnia
Irritability
Weakness
Paranoia
Depression
Anxiety
Lack of sex drive
Water retention
Rapid weight gain or loss
Problems with processing sugars
Problems walking
Cracked skin at the corners of the mouth
Read more: http://www.testcountry.org/vitamin-b6-deficiency.htm#ixzz1MKcaGGDS
0 - ArchivalUser - 05-14-2011
@javid
u r welcome
@sheeom
thanx for info