WBR0620

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 43 year old male, comes to the office with complaints of fatigue and lethargy over the past several years. His wife says he has loss of libido and erectile dysfunction for the past few years. Previously they had a normal sexual life. On further review of history, he says he had intermittent abdominal pain and joint pains for several years for which he never consulted a doctor. His past history is otherwise insignificant and his family history is unremarkable. He says he takes calcium and multivitamin tablets to keep him healthy. He does not smoke and drink. On examination, his temperature is 36.7 C, blood pressure is 130/70 mmHg, pulse is 72/min and reparations are 16/min. Abdominal examination reveals mild hepatomegaly. His skin has golden blue hue. With respect to the disease, which of the following the patient has to avoid?]]
Answer A	AnswerA::Vitamin D
Answer A Explanation	[[AnswerAExp::Incorrect : Hemochromatosis may result in osteoporosis due to liver damage induced Vit D mal-absorption and deficiency and these patients requireVitamin D.]]
Answer B	AnswerB::Vitamin A
Answer B Explanation	[[AnswerBExp::Incorrect : Hemochromatosis may result in liver damage induced Vit A mal-absorption and deficiency and these patients require Vitamin A.]]
Answer C	AnswerC::Vitamin C
Answer C Explanation	[[AnswerCExp::Correct : Ascorbic acid (vitamin C) may enhance the liberation of free iron and the generation of reactive oxygen species. Ingestion of large quantities of vitamin C has been rarely associated with fatal cardiac arrhythmias in patients with iron overload, presumably due to oxidative injury.]]
Answer D	AnswerD::Vitamin B
Answer D Explanation	[[AnswerDExp::Incorrect : There is no need to avoid Vitmain B in this patient.]]
Answer E	AnswerE::Vitamin E
Answer E Explanation	[[AnswerEExp::Incorrect : Hemochromatosis may result in liver damage induced Vit E mal-absorption and deficiency and these patients require Vitamin E.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::Hemochromatosis is a hereditary disease characterized by improper dietary iron metabolism (making it an iron overload disorder), which causes the accumulation of iron in a number of body tissues. C282 Y mutations in HFE gene cause excessive amounts of iron to be absorbed. Iron accumulation can eventually cause end organ damage, most importantly in the pancreas manifesting as diabetes and liver failure. Other manifestations are impotence; loss of libido,osteoporosis, amenorrhe, heart failure and hypothyroidism. Liver failure may result in mal-absorption of fat soluble vitamins like A, D, E, K and coagulation abnormalities that require vitamin K. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Hemochromatosis
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::