A 78-Year-Old Man Comes to the Office Due to a One-Month

question 76

Multiple Choice

A 78-year-old man comes to the office due to a one-month history of progressive dyspnea, generalized weakness, fatigue, and palpitations.  He also reports tingling and numbness in both lower limbs.  His daughter, who is visiting from another state, adds that since his wife's death a year ago, the patient has not been taking care of himself.  Blood pressure is 105/50 mm Hg and pulse is 104/min.  Cardiovascular examination shows a displaced apical impulse at the sixth intercostal space, a third heart sound, and high-volume, collapsing carotid pulses.  Bilateral basal crackles, 2+ bilateral pedal edema, and mild hepatomegaly are also present.  Neurologic examination shows decreased light touch and vibration sense in the feet, with decreased knee and ankle reflexes bilaterally.  Laboratory evaluation shows normal blood counts.  Deficiency of which of the following nutrients is most likely responsible for this patient's symptoms?

• A)Ascorbic acid
• B)Cobalamin
• C)Niacin
• D)Pyridoxine
• E)Retinol
• F)Riboflavin
• G)Thiamine

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Definitions:

Measurement

The process of quantitatively assessing or determining the magnitude, amount, or degree of something.

Calculation

The process of using mathematical techniques to determine a numerical result or assess a financial situation.

Post-Decisional Justification

The cognitive process where individuals convince themselves that the choice they made was the best possible option, often to reduce dissonance after making a difficult decision.

Limitations

Restrictions or constraints that define the boundaries within which a process or activity can occur.