Question 1

Question:

A 90-year-old woman presents for her routine doctor’s checkup. She complains of lethargy, weakness, and tingling sensation in her fingers and toes. Her eyesight has also deteriorated. On physical examination, her tongue is inflamed, and her conjunctivae are pale. Labs show that her haemoglobin is 9.8 g/dL, and her MCV is 115 μm3. Which of the following nutritional deficiencies does she most likely have?

Correct Answer: E. Vitamin B12

This woman suffers from vitamin B12 deficiency (choice E). Signs and symptoms of this include a macrocytic anemia, glossitis, and neurologic findings (paresthesias, and optic neuropathy, and subacute combined degeneration.
Folate deficiency (choice A) also causes a macrocytic anemia, but it does not cause neurologic symptoms. Iron deficiency (choice B) causes a microcytic anemia. Vitamin B2, or riboflavin (choice C), is a cofactor in oxidation and reduction. Deficiency causes angular stomatitis, cheilosis, and corneal vascularization. Vitamin B3, or niacin (choice D), is also used in oxidation and reduction reactions. Deficiency causes pellagra, which manifests as diarrhea, dermatitis, and dementia.