brownstone
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recently my friend too the usmle and he saw a question accompanied with a picture.....it was about an elderly man who had lost his wife and was now with a few months of depression. He took up a "tea and toast" diet and the question was accompanied with a picture showing ecchymosis of the lower extrimities. The etiology was due to hypocalcemia, but i haven't a clue as to the pathophysio. Anyone with an idea....
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| mjl1717
Forum Hero
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Vitamin C def/Scurvy could be in the differential
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| dev
Forum Guru
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Most of the questions generally based on old men living alone,cooking for themselves are generally suggestive of VIT C def.what do u mean by etiology hypocalcemia??echymosis caused by hypocalcemia??
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| brownstone
Forum Newbie
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the person who took the exam told me that they thought the answer was hypocalcemia because the lack of calcium would somehow affect the clotting factor cascade. I wasn't sure about this answer but I can see how vitamin C deficiency could be the real etiology.
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| ditch doctor
Forum Junior
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It's Vit C def. That's straight out of Goljan's lectures, p 103 of the general path lectures. Also in BRS p 127. Kaplan is surprisingly void of nutritional disorders. Hmm...
Anyway, don't tell your friend this, but he probably got the question wrong. If it had to do with calcium, it would probably be some sort of osteomalacia/ vitamin D deficiency question.
Vit K deficiency would give you bruises, but that is usually due to antibiotics screwing up the gut flora, not a "tea and toast" diet.
Again, I'm pretty sure it's Vit C. All the bruising is from impaired synthesis of hydroxyproline and hydroxylysine, for which Vit C is a cofactor. Defective collagen => fragile capillaries => abnormal bleeding.
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| Addicudo
Forum Guru
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Tea and Toast diet - Leads to Folic Acid deficiency - causes Megaloblastic Anemia ... (Kaplan - Page 192) ...
Folic Acid - Decreased - DNA synthesis affected ... Effecting all cell lineages ... therefore may also affect Platelets .. and show Ecchymosis in the periphery !!! ...
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