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:

Economic Conditions

The state of the economy at a given time, including factors such as employment rates, inflation rates, and gross domestic product.

Speculative Motive

The intention to hold cash or assets in anticipation of making profits from expected changes in their prices or exchange rates in the future.

Inflation

The pace at which the overall cost of goods and services increases, causing the value of money to decrease.

Money Supply

The total volume of economic monetary assets, such as cash, coins, and the balances in checking and savings accounts, at a specific period.