a wikitestprep question

[psychforme]

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#904
A 6 year old male child is brought into the pediatrics clinic. According to his parents he has been having diarrhea, a red rash. They also report that at times, he is "somewhat uncoordinated in his walking." A thorough evaluation does not reveal any nutritional deficiencies. Which of the following do you expect to see?

A. Elevated neutral amino acid in his urine
B. Reduced levels of tryptophan
C. Lead poisoning
D. A history of viral infection in the gastrointestinal tract
E. An autosomal dominant condition upon genetic analysis

They claim that A is correct. So a kid with a rash and diarrhea should be worked up for Hartnup's disease instead of assuming he had a rotavirus gastroenteritis? Because rotavirus does not explain the totality of this kids problems? What totality? A rash and a ****ing diarrhea? Paroxysmal uncoordinated walking? Yeah that sounds like specific symptoms! I'd be more worried if a kid never had a rash or a diarrhea.

Lame.

 

[RisingSun]

#904
A 6 year old male child is brought into the pediatrics clinic. According to his parents he has been having diarrhea, a red rash. They also report that at times, he is “somewhat uncoordinated in his walking.” A thorough evaluation does not reveal any nutritional deficiencies. Which of the following do you expect to see?

A. Elevated neutral amino acid in his urine
B. Reduced levels of tryptophan
C. Lead poisoning
D. A history of viral infection in the gastrointestinal tract
E. An autosomal dominant condition upon genetic analysis

They claim that A is correct. So a kid with a rash and diarrhea should be worked up for Hartnup's disease instead of assuming he had a rotavirus gastroenteritis? Because rotavirus does not explain the totality of this kids problems? What totality? A rash and a ****ing diarrhea? Paroxysmal uncoordinated walking? Yeah that sounds like specific symptoms! I'd be more worried if a kid never had a rash or a diarrhea.

Lame.

I get the photosensitivity and ataxia thing. I've gotten used to looking for zebras when presented with horses. But why is A more correct than B? I understand that Hartnup is a decrease in absorption of neutral amino acids but isn't the whole point of the disease that you are primarily deficient in tryptophan?

 

[psychforme]

I think both A and B are wrong. People without a history of viral gastroenterities do not exist. D is the correct answer. You don't hear about a "rash" and go thinking "OHHH!!! Hartnups disease!"

 

[Depakote]

I get you. Rotavirus is definitely on the top of my differential for ataxia in a young child.

 

[BoneNibbler]

MY guess is "A"

 

[rahulb]

I think both A and B are wrong. People without a history of viral gastroenterities do not exist. D is the correct answer. You don't hear about a "rash" and go thinking "OHHH!!! Hartnups disease!"

it's ok not everyone can score above average. perhaps you should reconsider your sense of self-worth and accept the fact that you're destined for mediocrity. 😉

 

[psychforme]

I get you. Rotavirus is definitely on the top of my differential for ataxia in a young child.

The question did not ask for a differential on a presumed ataxia. The question ask what do I expect to see in this patient? I expect to see a history of viral gastroenteritis in every child.

Why would you not expect to? Does ataxia somehow protect children from viral gastroenteritis? That's news to me.

 

[psychforme]

it's ok not everyone can score above average. perhaps you should reconsider your sense of self-worth and accept the fact that you're destined for mediocrity. 😉

The problem is the person who wrote the question is dumber than me. Usually the case when I am wrong on a question.

 

[psychforme]

MY guess is "A"

A is wrong. All kids have a history of viral gastroenteritis.

 

[psychforme]

I guess it is the bane of humanity. Dumb people don't understand that they are dumb.

 

[NCF145]

I get the photosensitivity and ataxia thing. I've gotten used to looking for zebras when presented with horses. But why is A more correct than B? I understand that Hartnup is a decrease in absorption of neutral amino acids but isn't the whole point of the disease that you are primarily deficient in tryptophan?

Yeah, this is a good example of pellagra caused by Hartnup's. Why A is better than B is up for debate. With Hartnup's, you are deficient in tryptophan and you also excrete neutral amino acids. It is a very poorly written question.

 

[sebsvenmdc]

I get the photosensitivity and ataxia thing. I've gotten used to looking for zebras when presented with horses. But why is A more correct than B? I understand that Hartnup is a decrease in absorption of neutral amino acids but isn't the whole point of the disease that you are primarily deficient in tryptophan?

They don't describe what tryptophan either. Like, are we talking serum tryptophan or absorbed (GI, not renal) tryptophan. I think their little description about no nutritional deficiencies was supposed to make you rule out B. Lol, don't stress about it.

 

[NCF145]

They don't describe what tryptophan either. Like, are we talking serum tryptophan or absorbed (GI, not renal) tryptophan. I think their little description about no nutritional deficiencies was supposed to make you rule out B. Lol, don't stress about it.

If the child didn't have any nutritional deficiencies, then he shouldn't be manifesting symptoms of pellagra. Correct?

 

[sebsvenmdc]

If the child didn't have any nutritional deficiencies, then he shouldn't be manifesting symptoms of pellagra. Correct?

I interpret no nutritional deficiencies to mean no dietary deficiencies...just like a patient is hardly ever deficient in dietary B12...unless he/she is a crazy vegan. Is that wrong? Does nutritional deficiency include an assessment of absorption? I thought it didn't.

 

[psychforme]

I interpret no nutritional deficiencies to mean no dietary deficiencies...just like a patient is hardly ever deficient in dietary B12...unless he/she is a crazy vegan. Is that wrong? Does nutritional deficiency include an assessment of absorption? I thought it didn't.

I'm totally with you sven.

 

[NCF145]

I interpret no nutritional deficiencies to mean no dietary deficiencies...just like a patient is hardly ever deficient in dietary B12...unless he/she is a crazy vegan. Is that wrong? Does nutritional deficiency include an assessment of absorption? I thought it didn't.

I don't think you are wrong in that understanding. I just looked at the question in the following way. The person has what looks to be pellagra. Pellagra, by definition, is a deficiency of niacin. What causes niacin deficiency?

1. Hartnup's
2. B6 deficiency
3. Carcinoid

The last two don't apply here, leaving us with Hartnup's. The only way for Hartnup's to manifest as pellagra is if there is low enough levels of tryptophan in the body (either by decreased uptake from the GI or increased excretion from the kidney) to, in turn, decrease synthesis of niacin. Therefore, if this indeed is Hartnup's presenting in the manner described in the question, there has to be a deficiency of tryptophan. There will also be increased neutral amino acids in the urine. Both answers are correct. Which leaves us with only one true answer, F, the writer of the question was an idiot.

 

[Whats_up_doc]

I don't think you are wrong in that understanding. I just looked at the question in the following way. The person has what looks to be pellagra. Pellagra, by definition, is a deficiency of niacin. What causes niacin deficiency?

1. Hartnup's
2. B6 deficiency
3. Carcinoid

The last two don't apply here, leaving us with Hartnup's. The only way for Hartnup's to manifest as pellagra is if there is low enough levels of tryptophan in the body (either by decreased uptake from the GI or increased excretion from the kidney) to, in turn, decrease synthesis of niacin. Therefore, if this indeed is Hartnup's presenting in the manner described in the question, there has to be a deficiency of tryptophan. There will also be increased neutral amino acids in the urine. Both answers are correct. Which leaves us with only one true answer, F, the writer of the question was an idiot.

.

 

[sebsvenmdc]

I don't think you are wrong in that understanding. I just looked at the question in the following way. The person has what looks to be pellagra. Pellagra, by definition, is a deficiency of niacin. What causes niacin deficiency?

1. Hartnup's
2. B6 deficiency
3. Carcinoid

The last two don't apply here, leaving us with Hartnup's. The only way for Hartnup's to manifest as pellagra is if there is low enough levels of tryptophan in the body (either by decreased uptake from the GI or increased excretion from the kidney) to, in turn, decrease synthesis of niacin. Therefore, if this indeed is Hartnup's presenting in the manner described in the question, there has to be a deficiency of tryptophan. There will also be increased neutral amino acids in the urine. Both answers are correct. Which leaves us with only one true answer, F, the writer of the question was an idiot.

Yeah, we're on the same page. I think the question meant to lead the reader to infer that there was no GI lumenal deficiency because there was no nutritional deficiency...kind of a silly option though! Because without including "absorbed" tryptophan or "plasma" tryptophan vs. "lumenal" tryptophan...you can't exclude B.

And the Hartnup's thing is solid. I just remembered that the the transporter is the same in the GI and the kidneys. The increased renal excretion is due to the same mulfunctioning transporter of absorption in the PCTs.