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* NBME Question 2
 #834014  
  hengh2 - 11/23/16 22:17
 
  3.) A 78-year-old woman comes to the office for an annual health maintenance examination. She says she has been generally healthy but has noticed that her energy level has been gradually decreasing during the past 3 months. She also has had difficulty formulating her thoughts during this time. She has not noticed any blood in her urine or stool. She lives alone. Medical history is unremarkable and she takes only a daily multivitamin supplement and echinacea, which she hopes will prevent upper respiratory infections. She does not smoke cigarettes or drink alcoholic beverages. Her diet consists of various foods, predominantly of animal origin. The patient appears slightly pale. She is 160 cm (5 ft 3 in) tall and weighs 46 kg (102 lb); BMI is 18 kg/m2. Weight is unchanged from 1 year ago. Vital signs are temperature 37.0C (98.6F), pulse 80/min, respirations 20/min, and blood pressure 138/78 mm Hg. Auscultation of the lungs and heart discloses no abnormalities. Neurologic examination shows decreased position sense in the toes bilaterally. Mini-Mental State Examination score is 29/30. Results of laboratory studies are shown:


Serum Blood
Folic acid 8 ng/mL (N>2) Hematocrit 33%
Hemoglobin 11.0 g/dL
WBC 5600/mm3
MCV 106 μm3
Platelet count 220,000/mm3



Which of the following is the most likely underlying cause of this patient's anemia?


A ) Adverse effect of echinacea


B ) Gastric achlorhydria


C ) Hemolysis


D ) Inadequate dietary intake of fruits and vegetables


E ) Occult blood loss

 
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* Re:NBME Question 2
#3318864
  ktrina - 11/24/16 23:41
 
  bbb  
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* Re:NBME Question 2
#3318867
  geniculate - 11/25/16 00:20
 
  I agree with Ktrina:

With old age levels of gastric reduces, which can cause deficiency in B12 and Iron among other nutrients.

Neurologic examination shows decreased position sense in the toes bilaterally. It confirms B12 deficiency.

The fact the patient's diet included animal protein, it rules out Folate deficiency.

Echinacea can cause thrombocytopenia and bleeding problems, but no Neurological deficits.

 
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* Re:NBME Question 2
#3323690
  qikjon - 01/10/17 21:11
 
  BB  
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