Internal-Medicine

Questions: 91–102 67
For each patient with vitamin deficiency or excess,
select the most likely diagnosis.
98. An 83-year-old man with poor nutrition notices
easy bruising and bleeding gums. On examination,
he has inflamed bleeding gums, multiple
areas of ecchymoses, and perifollicular
hemorrhages. His coagulation profile and liver
function is normal.
99. A 26-year-old woman started developing frequent
headaches, dizziness, and double vision
after starting a “megavitamin” program. Her
examination is normal except for papilledema.
100. A 57-year-old man has dyslipidemia with a low
HDL and high triglyceride pattern. Recently
the dose of one of his medications was increased
and he started experiencing flushing and
pruritus secondary to histamine release.
101. A 43-year-old woman with chronic alcoholism
presents with shortness of breath and
edema. On examination, her blood pressure is
100/60 mm Hg, pulse 110/min, JVP is 8 cm, the
cardiac apex is displaced and enlarged, there
are bilateral inspiratory crackles, and there is
pedal edema.
102. A 52-year-old alcoholic notices a skin rash on
his chest, and also has symptoms of diarrhea
and abdominal pain. On examination, he has a
scaly and pigmented rash on the sun-exposed
areas of his skin, the abdomen is soft, and his
short-term memory is impaired. He has dermatitis,
diarrhea, and dementia syndrome.