“MRCPCH Part 2 Exam Recall: Most Repeated Questions You Must Know”

Ans- a

Explanation

Reasoning

Underlying condition

• Progressive intrahepatic cholestasis → chronic cholestatic liver disease → impaired bile secretion.
• Bile is essential for absorption of fat‑soluble vitamins (A, D, E, K).
• Chronic cholestasis → high risk of fat‑soluble vitamin deficiencies.

Current presentation

• Jaundice, pruritus, scratch marks → from cholestasis.
• Ataxia + neurological signs → points toward a vitamin deficiency that affects the nervous system.

Which vitamin deficiency fits?

Vitamin	Deficiency effects	Fits this case?
Vit E	Neurological: ataxia, peripheral neuropathy, loss of proprioception/vibration sense; due to demyelination of posterior columns & spinocerebellar tracts	✅ Yes — classic in chronic cholestasis
Vit B12	Subacute combined degeneration, anemia; water‑soluble, not primarily affected by cholestasis	❌
Vit A	Night blindness, xerophthalmia	❌
Vit D	Rickets/osteomalacia	❌
Vit B1	Beriberi, Wernicke’s encephalopathy; water‑soluble	❌

Key point

In cholestatic liver disease, Vitamin E deficiency is the most common cause of neurological symptoms like ataxia in children and adolescents.

✅ Correct answer: a. Vitamin E deficiency

*** Exam Pearl

Vitamin E

Vitamin E works predominantly as an antioxidant, protecting polyunsaturated fatty acids in cellular membranes from peroxidation and plays a role in inhibiting cell proliferation and platelet aggregation. Rich dietary sources include plant oils, nuts, seeds and whole wheat products. As with all fat- soluble vitamins, patients with fat malabsorption are at increased risk of deficiency and presents with neuromuscular and haemolytic disorders.

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