MEDizzy - An 86-year-old man is brought to the emergency department by

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USMLE I Test Block III

An 86-year-old man is brought to the emergency department by his daughter because of increased bruising of recent onset. The daughter has noticed multiple bruises on her father’s arms and legs over the past few months. The patient lives by himself and gives no history of trauma. The patient does complain of pain and bleeding in his gums as well as increased joint pain. He has also noticed a rash on his buttocks. Vital signs are stable. Laboratory studies show: WBC count: 4000/mm³ Hemoglobin: 10.3 g/dL Platelet count: 235,000/mm³ Activated partial thromboplastin time: 27 seconds Prothrombin time: 12 seconds Which of the following is the best treatment for this patient?

ExplanationThe correct answer is D. Vitamin C (ascorbic acid) deficiency or scurvy typically presents in elderly, malnourished patients as fatigue, anemia, gingivitis, and arthralgias. A rash like the one seen in the image represents the purpuric, perifollicular rash that may be seen on the legs or buttocks of patients with ascorbic acid deficiency. This patient’s clinical presentation is consistent with scurvy, which is treated with replacement of ascorbic acid.