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questions:
1. What is the most likely diagnosis? Justify.
58 years old female
chief complaint: weakness, dizziness, anorexia, nausea and occasional vomiting for
3 months
shortness of breath, numbness and tingling in extremities
Most likely diagnosis: Cobalamin deficiency
Case3
A 9 month old female is brought to the pediatric clinic because of listlessness and
anorexia. She
is the daughter of an unemployed poor urban couple and has never before seen a
pediatrician or
taken any medication. Her parents report a diet of unsupplemented cows milk.
Physical examination reveals weakness, pallor, hyperkeratosis and hemorrhagic
perifolliculitis of
the skin of the lower extremities, forearms, and abdomen. There are purpuric skin
rashes,
splinter hemorrhages in the nail beds of the hands, tenderness and swelling of the
distal femur
and costochondral junctions. There are bleeding gums, and petechiae are seen over
the nasal and
oral mucosa.
The CBC reveals microcytic, hypochromic anemia, and leukopenia. Plasma and
platelet levels
of ascorbic acid are low. The bleeding time is prolonged.
X-rays show subperiosteal hemorrhages, both legs and knees show ground glass
appearance of
bones and epiphyses.
QUESTIONS
1. What is the most likely diagnosis? Justify your answer
9 month old female
Chief complaint: listlessnessa, anorexia
Likely diagnosis: Scurvy
Patient symptoms
Physical Examination:
Bleeding gums
Subperiostial hemorrhage
Hydroxylation of collagen resulting to
ground glass appearance of
epiphyseal plates
leukopenia
Prolonged bleeding test results
Hemorrhagic perifolliculitis