Why Vitamin B12 Deficiency Should be on your Radar Screen

<strong>Vitamin</strong> <strong>B12</strong> <strong>Deficiency</strong>
Pretest and Posttest
If you want to receive continuing education credit for
this program, complete this posttest. Please read the
case history and then answer the questions that follow.
Choose the answer that is most correct for each
question.
Case
A 60-year-old teacher with a history of hypothyroidism
and gastroesophageal reflux disease (GERD) reports
significant fatigue, hot flashes, and memory difficulty
since her last annual visit. On detailed review of
symptoms, she also admits to irritability, emotional
lability, decreased appetite, difficulty sleeping, and
occasional tingling of her fingertips. Her last monthly
period was 2 years ago. She has <strong>be</strong>en following a
vegetarian diet for the past 5 years to try to lose weight.
During the physical examination, she is alert and
oriented x 3, but tearful at one point during the
interview with an MMSE score of 28 out of 30. There are
no abnormal physical findings.
Her CBC results:
RBC 4.6 (4.2–5.8) 10^6/µL
MCV 90 (78–102) fL
Hgb 15 (12.0–16.0) g/dL
WBC 6.4 (4.3–11.0) 10^3/µL (normal differential)
Plts 312 (144–440) 10^3/µL
Smear shows normocytic, normochromic RBCs
Chemistry results:
Na 139 (136–148) mEq/L
K 4.7 (3.5–5.5) mEq/L
Cl 103 (98–110) mmol/L
BUN 20.0 (9.34–23.35)mg/dL
Cr 1.0 (0.4–1.5) mg/dL
CO2 25 (21–33) mmol/L
Gluc 80 (60–140) mg/dL
GOT 26 (1–32) U/L
GPT 14 (1–30) U/L
AlkPhos 115 (31–121) U/L
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