MRCPCH: These recall-based questions reflect the style, topics, and difficulty level seen in the actual paper. Whether you’re taking your first attempt or re-sitting, this insight into MRCPCH Part 2 real exam cases can help you focus on high-yield topics and common pitfalls.
Recall: A teenage female known case of progressive intrahepatic cholestasis, presented with jaundice, pruritus with scratch marks, ataxia and neurological signs. What is the cause?
a.Vit E
b.Vit B12
c.Vit A
d.Vit D
e. B1
Review ExplanationAns- 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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