Question 6
(Source: www.futurehealth.rochester.edu)
An 80 year of Caucasian male is brought to the physician due to skin bruises and is accompanied with his son and daughter in law. The man says he stays alone since his wife died 3 years ago. He has no other significant medical illness. He denies smoking, drinks wine sometimes, and never have used any recreational drugs. He denies any guilt feelings, or any abnormal perceptions. He says he used to walk daily for 5 miles earlier but have lost interest since last 3 years, and rather prefers to stay at home alone. He has lost about 4 lbs. in last 3 years, and has decreased appetite. when asked about his diet he says "since his wife has passed away, there is no one to cook. So he most often eats toast with tea". He occassionally has bleeding while brushing his teeth. His skin examination looks as in the picture above. He denies any falls or abuse, and says "I am perfectly fine, my kids are just anxious". His memory appears to be intact. What is the most likely diagnosis?
A) Elderly Abuse
B) Elderly Neglect
C) Alzheimers
D) Nutritional deficit
E) Hypothyroidism
F) Depression
G) Coagulopathies
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1 comments:
Answer: D) Nutritional Defect (Vit C deficiency)
Points to note:
Vit C deficiency is common cause of perifollicular hemorrhage as shown in the picture above. Most often, it will give a history of patient being on "Tea and Toast diet". Look for swollen gums and bleeding while brushing.
Memory and cognitive function is intact unless there are other vitamin factors deficiency.
Misleaders:
Death of wife and depression like symptoms (No significant weight loss. In depression >5% weigth loss is common, no suicidality, no delusions, hallucinations)
Elderly Abuse: This could be a possibility but Vit C deficiency is evident from the given scenario.
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