What is the reason for patients tachycardia

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Reference no: EM133844687

Question

A 67-year-old woman complains of fatigue, weight loss, and anxiety. She complains that she is tired and fatigue despite having 8 hours of sleep at night and at times needed to rest on the couch because her legs sometimes feel numb off and on and she is afraid of losing her balance. She complains that her appetite has been poor over the past 2 months with postprandial epigastric discomfort after most meals. She has tried antacids and avoided spicy foods while maintaining a well-balanced diet, however, her symptoms persisted, and she estimates a 10-pound weight loss. She denies a history of HTN, CAD, DM, osteo/rheumatoid arthritis or any hematological or neurological diseases.

Physical exam findings: T = 98.6 F (oral), BP 132/74 mmHg (left arm, sitting), HR 98 beats/min (regular), RR 16 breaths/min (unlabored). BMI 17.9 kg/m2. The neurological examination is significant for decreased lower extremity muscle strength (3/5), and deep tendon reflexes (1+) bilaterally. The patient is slow to stand from a sitting position, and her gait also appears slower than expected.

Laboratory findings: Hemoglobin and hematocrit are decreased; reticulocyte count is decreased; platelets and white blood cells are normal. Mean cell volume (MCV) is increased, with a normal mean cell hemoglobin (MCH) and mean cell hemoglobin concentration (MCHC). Ferritin and serum iron are normal, folic acid mildly decreased, and vitamin B12 decreased. She is anti-Intrinsic factor antibody positive. A blood smear shows hyper segmented polymorphonuclear leukocytes. Liver, kidney, and thyroid function levels are al WNLs.

Case Study Questions:

1. What is the reason for the patient's tachycardia?

2. What is the most likely diagnosis?

3. What is the mechanism of the neurological findings?

Reference no: EM133844687

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