Question

Case 4:

A 52-year-old female presents to the clinic with fatigue for 4 months, shortness of breath, RUQ pain, and a persistent tingling sensation in both hands and feet for 1 month. Patient diagnosed as pre-diabetic 4 years ago, had gastric bypass surgery one year ago. On physical exam: patient shows pale skin, dyspnea, stocking-glove tingling distribution with decreased vibration and positional sense. Lab test reveals decreased intrinsic factor production. Blood glucose test is normal.

Q: What are your differential diagnoses? Why?

Answer 1

PATIENT HISTORY

The patient has the present medical history of fatigue for 4 months, shortness of bearth, RUQ pain persistent, tingling sensation in both hands and feet for 1 month

On examination: Patient shows pale skin, dyspnea, stocking glove tingling distribution with decreased vibration and positional sense

Lab test : decreased intrinsic factor production, blood glucose level

Past medical hsitory : prediabetic - 4 years ago , gastric bypass surgery 1 year ago

On detailed examination of the patient history, and physical examination, the patient is having Vitamin B12 deficiency.

It can be defined as low levels of stored B12 in the body that can result in anemia. The etiology in case of the patient is gastric bypass surgery, which is the surgery in which the stomach is divided into a small upper pouch and a much larger lower 'remnant' pouch and then the small intestine is rearranged to connect to both. One of the cause of Vitamin B12 deficiency is removal or destruction of the stomach.

Book Picture	Patient Picture
Common symptoms - Weakness and fatigue Light headed ness and dizziness palpitations and rapid heart rate shortness of breath a sore tongue that has a red beefy appearnce nausea or poor appetite weight loss diarrhea yellowish tinge to the skin and eyes Long time symptoms NUmbness and tingling in the hands and feet difficulty walking muscle weakness irritability memory loss dementia depression	fatigue for 4 months shortness of breath tingling sensation in both hands and feets for 1 month with decreased vibration and positional sense pale skin