Beriberi
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Beriberi
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USMLE® Step 1 style questions USMLE
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A 56-year-old man comes to the clinic with generalized fatigue and dyspnea on exertion that he noticed over the past month. He now becomes breathless after walking up a flight of stairs. He has also noticed numbness in his lower limbs over the last 2 weeks. Past medical history includes chronic pancreatitis. He has been drinking a pint of vodka daily for the past 25 years. Temperature is 37.0°C (98.6°F), pulse is 92/min, respirations are 19/min, and blood pressure is 135/85 mmHg. BMI is 20 kg/m2. He is alert, cooperative, and oriented to time, place, and person. Neurological examination reveals symmetrical peripheral neuropathy in a “stocking and glove” distribution with defective perception of touch and vibration sensation. Motor strength is 3/5 in the lower limbs and 5/5 in the upper limbs bilaterally. Symmetrical muscle wasting is noted in both lower limbs. Deep tendon reflexes are absent at the ankles bilaterally. On cardiac auscultation, a 3rd heart sound is heard, and the apical impulse is displaced to the 6th intercostal space. Romberg sign is negative. Laboratory investigations are shown below:
Serum methylmalonic acid levels are normal. This patient’s condition is most likely associated with which of the following impaired biological processes?
Laboratory value | Result |
Complete blood count | |
Hemoglobin | 13 g/dL |
Hematocrit | 40% |
Leukocyte count | 5,000/mm3 |
Platelet count | 150,000/mm3 |
MCV | 88 fL |
Serum methylmalonic acid levels are normal. This patient’s condition is most likely associated with which of the following impaired biological processes?
External References
First Aid
2024
2023
2022
2021
Alcoholism p. 589
wet beriberi p. 720
Beriberi
cardiomyopathy p. 315
vitamin B1 deficiency p. 64
Dilated cardiomyopathy p. 315, 316, 477
wet beriberi p. 64
Dry beriberi p. 64
Edema
wet beriberi p. 64
Wet beriberi p. 64
Summary
Beriberi is a disease caused by a deficiency of thiamine (vitamin B1). This can be due to reduced intake, or a problem with thiamine absorption. Beriberi can exist as wet beriberi, which is when it mainly affects the cardiovascular system causing high-output heart failure with symptoms like dyspnea, and peripheral edema. There can also be dry beriberi, causing symptoms like wasting, and paralysis due to nerve damage. Dry beriberi usually presents with peripheral neuropathy, confusion, and nystagmus (involuntary eye movements).