<prompt> A chronic alcoholic presenting with bleeding gums and petechiae is more likely to have deficiency of:Vitamin B12Vitamin CThiaminePyridoxine  <response>: Ans: B Vitamin C Ref: Harrisons Principles of Internal Medicine, 18th edExplanation:Principal Clinical Findings of Vitamin MalnutritionNutrientClinical FindingDietary Level per Day Associated with Overt Deficiency in AdultsContributing Factors to DeficiencyThiamine Beriberi Neuropathy Muscle weakness Wasting Cardiomegaly Edema Ophthalmoplegia Confabulation0.3 mg1000 kcalAlcoholism,chronic diuretic use hyperemesisRiboflavin Magenta tongue Angular stomatitis Seborrhea Cheilosis0.6 mg Niacin Pellagra Pigmented rash of sun-exposed areas Bright red tongue Diarrhea Apathy Memory toss Disorientation9.0 niacin equivalentsAlcoholismVitamin B6 deficiency Riboflavin deficiency Tryptophan deficiencyVitaminB6 Seborrhea Glossitis Convulsions Neuropathy Depression Confusion Microcytic anemia: 0.2 mgAlcoholismIsoniazidFolate Megaloblastic anemia Atrophic glossitis Depression Homocysteine100 mcgdAlcoholism.Sulfasalazine PyrimethamineTriamtereneVitaminB12 Megaloblastic anemia Loss of vibratory and position sense Abnormal gait Dementia Impotence Loss of bladder and bowel control Homocysteine Methylmalonic acid1.0 mcgdGastric atrophy pernicious anemia terminal ileal disease, strict vegetarianism, acid- reducing drugs e.g., H2. blockersVitami n C Scurvy Petechias Ecchymosis Coiled hairs Inflamed and bleed, ng gums Joint effusion Poor wound healing10 mgdSmokingAlcoholismVitamin A Xerophthalmia Night blindness Bitots spots Follicular hyperkeratosis Impaired embryonic development Immune dysfunction300 mcgdFat malabsorption.InfectionMeaslesAlcoholismProtein-energymalnutritionVitamin D Rickets Skeletal deformation Rachitic rosary Bowed legs Osteomalacia2 0 mcgdAging, lack of sunlight exposure, fat malabsorption, deeply pigmented skinVitamin E Peripheral neuropathy Spinocerebellar ataxia Skeletal muscle atrophy RetinopathyNot described unless underlying contributing factor is presentOccurs only with fat malabsorption or genetic abnormalities of vitamin E metabolismtransportVitamin K Elevated prothrombin time Bleeding10 mcgdFat malabsorption, fiver disease, antibiotic use 