Knowledge Check
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Sort the clinical manifestations (top) with the underlying cause (bottom):
Pallor
Koilonychia
Palpitations
Restless legs syndrome
Shortness of breath
Angular cheilitis
Pica
Alopecia
Headache
Chest pain
Iron deficiency
Anemia


True of false: patients rarely volunteer a history of pica; they must be asked specifically about the symptom.
a
True
b
False

A very rare presentation of iron deficiency is the Plummer-Vinson syndrome:
- Reported in < 0.1% of cases of iron deficiency.
- Associated with classic triad of:
- Dysphagia
- Iron deficiency anemia
- Upper esophageal webs
- Pathogenesis of Plummer-Vinson syndrome remains speculative:
- Depletion of iron-dependent oxidative enzymes may produce:
- Myasthenic changes in muscles involved in the swallowing mechanism
- Atrophy of the esophageal mucosa
- Formation of webs as epithelial complications
- Improvement in dysphagia after iron therapy provides evidence for an association between iron deficiency and postcricoid dysphagia.
- Depletion of iron-dependent oxidative enzymes may produce:

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