Case 9 question 4

Incorrect, choose again!

Good choice! The current guidelines recommend that all patients with IBD get routine micronutrient testing. There are no clear guidelines on which nutrients should be checked regularly, however, much of this decision is generally driven by the clinical history and exam. All patients with ileal Crohn’s disease should have a vitamin D, vitamin B12 and iron level checked. In addition, in patients who have been restricting fruits and vegetables, it is important to check a vitamin C level, as clinical scurvy has been identified in this population . Zinc deficiency as well as Vitamin B deficiency and iron deficiency have been associated with angular cheilitis and therefore should be included based on the physical exam in this patient.

Incorrect, choose again! This patient’s labs reveal a slightly elevated MCV. Copper deficiency typically causes a microcytic anemia, hence, there is no need to check a copper level in this patient.