Nutrition: thiamine deficiency in alcoholics: practice question

A PSM question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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PSM · Nutrition: thiamine deficiency in alcoholics

Sample item

A chronic alcoholic is brought with confusion, ataxia and horizontal nystagmus with ophthalmoplegia. Before giving intravenous glucose, which vitamin must be given?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Thiamine

Thiamine is a cofactor for carbohydrate metabolism, and glucose loading in a thiamine deficient patient can precipitate or worsen Wernicke encephalopathy. Thiamine should therefore be given before or along with glucose. Alcoholism, poor diets and polished rice diets are the settings of deficiency.

Option by option

  • A. Pyridoxine

    Pyridoxine deficiency causes neuropathy and sideroblastic anaemia, not this triad.

  • B. Cyanocobalamin

    Cyanocobalamin treats B12 deficiency, which does not cause this acute triad.

  • C. Folic acid

    Folic acid corrects megaloblastic anaemia and does not treat Wernicke encephalopathy.

  • D. Thiamine (correct)

    Correct. Thiamine prevents or treats Wernicke encephalopathy and should precede glucose.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this PSM question

What is the answer to this PSM question?

The best answer is D, Thiamine. Thiamine is a cofactor for carbohydrate metabolism, and glucose loading in a thiamine deficient patient can precipitate or worsen Wernicke encephalopathy.

Why is "Pyridoxine" not the answer?

Pyridoxine deficiency causes neuropathy and sideroblastic anaemia, not this triad.

Why is "Cyanocobalamin" not the answer?

Cyanocobalamin treats B12 deficiency, which does not cause this acute triad.

Why is "Folic acid" not the answer?

Folic acid corrects megaloblastic anaemia and does not treat Wernicke encephalopathy.

What concept does this question test?

It tests Nutrition: thiamine deficiency in alcoholics in PSM. Thiamine should therefore be given before or along with glucose. Alcoholism, poor diets and polished rice diets are the settings of deficiency.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nutrition: thiamine deficiency in alcoholics?

Practise biostatistics with small calculations until sensitivity, predictive values and risk measures are automatic. Then use the flashcards and the other PSM questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.