Fat-soluble vitamin deficiency and toxicity Quiz: Ace Your Exams

Get ready to dominate your medical and nursing exams by using our dynamic quizzes to elevate your knowledge and increase your confidence. Whether you're gearing up for the USMLE®, COMLEX®, or your next in-class assessment, Osmosis quizzes tackle key topics in pathology, diagnostics, and treatment approaches. By honing in on clinical readiness and decision-making, we make sure the knowledge you gain empowers you both in the classroom and in real-world practice. Jump in and supercharge your exam prep!

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A 15-year-old boy is brought to the office by his parents for the evaluation of progressive gait instability, dysmetria and dysarthria for the past several years. The patient enjoys hockey but can no longer play due to his worsening symptoms. The review of systems is significant for chronic abdominal pain and fatty diarrhea. The patient is concerned that he is the shortest boy in his class. Family history is noncontributory. Physical examination shows a lean boy with mucosal pallor and reduced muscle mass. Skin examination reveals multiple tense, grouped blisters on the forearms as well as excoriations. Examination of lower extremities shows bilateral motor weakness and loss of deep tendon reflexes and loss of sensation to joint position and vibration. Laboratory results are shown below:  
 
Laboratory features 
Laboratory value  Result 
 Hemoglobin  9 g/dL 
 Leukocyte count  8,000/mm3 
 Platelet count    230,000/mm3 
 Mean corpuscular volume  85/μm3 
 Reticulocyte count  4% 

Peripheral blood smear is shown.

A microscopy image shows red blood cells w/ varied shapes & 1 large, purple-stained cell, likely a blast, among them. Many RBCs have spiked edges.
Reproduced from:Wikimedia Commons   

MRI of the brain and spine shows spinocerebellar and posterior column cells degeneration. Which of the following is the most likely cause of this patient’s condition?  

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