Nutritional Deficiencies

Explanation: Night blindness occurs due to Vitamin A deficiency

Explanation: Niacin Deficiency – pellagra, Thiamin Deficiency – beri-beri

Reference: Davidson 23rd , Page : 718
Explanation : keshan’s disease ( cardiomyopathy in children ) occurs due to selenium deficiency .

Scurvy
Vitamin C deciency affects the normal synthesis of collagen and results in a bleeding disorder characterised by perifollicular and petechial haemorrhage, bruising and subperiosteal bleeding. The key to diagnosis is the dietary history

(Ref : Davidson 23rd ,p – 692 )

( Ref : Davidson 23rd ,p - 712 , box : 19.32 )

Explanation: Vitamins are organic substances with key roles in certain metabolic pathways, and are categorised into those that are fat-soluble (vitamins A, D, E and K) and those that are water-soluble (vitamins of the B complex group and vitamin C).

Stem Breakdown:

Confusion, ataxia, and nystagmus: This classic triad of symptoms is highly suggestive of Wernicke's encephalopathy, a neurological disorder associated with thiamine (vitamin B1) deficiency.
Chronic alcohol use: Chronic alcoholism is the most common cause of thiamine deficiency, leading to Wernicke's encephalopathy.
Rapid improvement with thiamine: This confirms that the symptoms were due to thiamine deficiency, which is rapidly reversible with appropriate supplementation.
Option Analysis:

A) Wernicke’s encephalopathy: This is the correct diagnosis. Davidson and Harrison both highlight that Wernicke’s encephalopathy is caused by thiamine deficiency, commonly seen in chronic alcoholics. The classic symptoms include confusion, ataxia, and ophthalmoplegia (nystagmus or other eye movement abnormalities). Rapid improvement with thiamine supports this diagnosis.
B) Korsakoff’s syndrome: Korsakoff's syndrome is a chronic sequela of untreated Wernicke’s encephalopathy, characterised by irreversible memory loss and confabulation. It does not cause rapid neurological improvement with thiamine administration.
C) Alcohol withdrawal: Alcohol withdrawal causes symptoms such as tremors, agitation, and hallucinations, but it does not typically present with the triad of confusion, ataxia, and nystagmus.
D) Hepatic encephalopathy: Hepatic encephalopathy occurs in patients with liver failure and is due to elevated ammonia levels. It presents with altered mental status but not with the other signs of Wernicke's (ataxia, nystagmus).

Davidson 23rd, Box-19.28

Explanation: Dry (or neurological) beri-beri manifests with chronic peripheral neuropathy and with wrist and/or foot drop, and may cause Korsakoff’s psychosis and Wernicke’s encephalopathy

Explanation: Red cell folate levels are a more accurate indicator of folate stores and tissue folate deficiency.

Hypercarotenaemia occurs due to excessive ingestion of carotene-containing vegetables or in situations of impaired metabolism such as hypothyroidism or anorexia nervosa.

A yellowish discoloration is seen on the face, palms and soles but not the sclera or conjunctiva, and this distinguishes it from jaundice 


Macledo 14th/P-26

Reference: Davidson 23rd , Page : 717 , Box : 19.34

Reference: Davidson 23rd , Page : 1233
Explanation : Niacin deficiency ( Vitamin B3 ) - pellagra can also seem in carcinoid syndrome.

Reference: Davidson 23rd , Page : 712 , Box : 29.32

( Ref : Davidson 23rd ,p –693 )