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KROK 1 2019 – Question 170 · KROK (Medicine) · Biological Chemistry

A 37-year-old man is admitted to hospital with mental confusion and disorientation. His wife reports he became more irritable and forgetful in the past year. In addition, she notes that he became a vegan a year ago, and currently, his diet consists of starchy foods like potatoes, corn, and leafy vegetables. GI symptoms include anorexia, diarrhea and vomiting. He has glossitis and skin lesions that appear as vesicles over the extremities. Eczema-like lesions around the mouth, as well as desquamation and roughened skin over the hands are also present. Neurologic examination reveals symmetrical hypesthesia for all types of sensation in both upper and lower extremities in a “gloves and socks” distribution. Deficiency in diet of which of the following amino acids is the most likely cause of this condition?

  1. A. Tryptophan
  2. B. Threonine
  3. C. Histidine
  4. D. Lysine
  5. E. Arginine
Hint

Recognise the nutritional deficiency behind the skin, gut and nervous system findings, then ask which essential amino acid can be converted in the body into the missing vitamin.

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