Question

A 69-year-old edentulous, alcoholic man who lives alone presents for evaluation of a shoulder wound that is not healing well. On physical examination, numerous ecchymoses are noted on the posterior aspect of his legs and thighs. Careful examination of the man's skin reveals minute hemorrhages around hair follicles, and splinter hemorrhages in the nail beds. Laboratory analysis is remarkable for a hemoglobin of 10 (normal 14 - 18 g/dL); no other hematologic abnormalities are noted.

What treatment should be included in therapy?

1. Administration of factor VIII
2. Administration of iron
3. Administration of vitamin B12
4. Administration of vitamin C
5 Administration of vitamin K

Answer 1

The patient's symptoms suggest scurvy, which is caused by a vitamin C deficiency. The appropriate treatment is administration of vitamin C to address the characteristic symptoms, such as poor wound healing and ecchymoses.

Step-by-step explanation:

The clinical presentation of the 69-year-old edentulous, alcoholic man suggests a deficiency in vitamin C, known as scurvy. The symptoms described, such as ecchymoses on the legs and thighs, minute hemorrhages around hair follicles, splinter hemorrhages in nail beds, and poor wound healing, are characteristic of scurvy, which is caused by a lack of vitamin C. This vitamin is essential for the normal synthesis of collagen, and without it, blood vessels become fragile leading to bleeding and poor wound healing. Since there are no other hematologic abnormalities noted in the laboratory analysis, this further supports a vitamin C deficiency rather than a coagulation factor or platelet disorder.

Therefore, the treatment that should be administered is vitamin C (option 4). Administering factor VIII, iron, vitamin B12, or vitamin K would not address the underlying cause of the symptoms in this patient's case, which is a deficiency of vitamin C. Hence, administration of vitamin C should be included in the therapy for this patient.