Fatigue And Weakness In A Perimenopausal Vegetarian Woman Assignment

Fatigue And Weakness In A Perimenopausal Vegetarian Woman Assignment

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A 52-year-old caucasian female patient presented with grievances of tiredness and feebleness for 3-4 months in the past. She runs often, and even with a multivitamin supplement and monitoring her sleep, which was normal, she could not run as usual. She has had abnormal menstrual patterns in the past year but says she does not have heavy bleeding. Her gynecologist thinks it could be perimenopause, and she was negative for urine hCG. The patient described his diet as vegetarian; he denies anxiety, depression, and any significant weight loss. Fatigue And Weakness In A Perimenopausal Vegetarian Woman Assignment

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The systems reviewed show asthenia, angular cheilosis, tongue soreness, mild hair loss, brittle nails, dyspnea on exertion, and constipation. She has no pain in her chest, palpitations, pain in the abdomen, queasiness, vomiting, diarrhea, hematemesis, melena, hematuria, dysuria, dizziness, blurred vision, headache, fever, rigors, night sweats, and easy bruising. Her past medical history includes irregular menstrual periods for the past nine months, a previous cesarean section done at the age of 28 years, and an appendectomy done at the age of 35 years. She resides with her spouse and the youngest child; she is an accountant and occasionally takes alcohol. She has a hypertension medical history in the past in her mother and hypertension, hyperlipidemia, and gout in her father. Fatigue And Weakness In A Perimenopausal Vegetarian Woman Assignment

On the physical examination, the patient is fully alert, well-oriented, and well-groomed with normal affect. Vital signs are normal. Her skin is rough without rash or any form of lesion; her nails are also brittle. There is also a slight anemia of the conjunctiva, healed angular stomatitis, and shiny and reddened tongue. The mucous membranes are noticeably pale to a lesser extent. The neck is not bulky, with no thyromegaly or lymphadenopathy. The patient has no shortness of breath, lung fields are clear, and there is no use of accessory muscles, the patient has a normal rate and rhythm without murmurs. The abdomen is not palpable, it is not tender, there is no visible distention and no organomegaly, and sounds in the bowel are normal. Cranial nerves II-XII are normal, and there is no delay in the patellar deep tendon reflexes. Fatigue And Weakness In A Perimenopausal Vegetarian Woman Assignment

The most probable diagnosis is vitamin B12 deficiency anemia; she is a vegetarian, and she complained of fatigue, weakness, angular cheilosis, sore tongue, mild pallor, brittle nails, and dyspnea on exertion. In this way, Vitamin B12 is necessary for synthesizing DNA in cells with a high rate of division, such as the cells in the bone marrow. Deficiency results in anemia, specifically megaloblastic anemia, which decreases the oxygen-carrying capacity of the blood and brings about fatigue and weakness (Cohen, 2023)Fatigue And Weakness In A Perimenopausal Vegetarian Woman Assignment. It also influences the nervous system and causes manifestations such as sore tongue and angular cheilosis because of epithelial cell alterations.

To confirm this diagnosis, the following tests should be ordered: A CBC to look for anemia, serum vitamin B12 and folate levels, a reticulocyte count, TSH and free T4, CMP, and a peripheral blood smear. These tests will assist in ascertaining B12 deficiency, excluding other causes of the symptoms, and check the general health status.

Vitamin B12 deficiency is treated through administration of the vitamin through tablets or injections according to the severity of the deficiency. Nutrition education is critical for the patient to take sufficient B12 in her diet since she is a vegetarian (Simeone et al., 2022). It is essential to monitor the treatment response B12 level, and CBC periodically.

The patient education should focus on compliance with the intake of foods containing B12 or supplements and follow-up. A multidisciplinary team, including a nutritionist, hematologist, gynecologist, and primary care physician, will lead to holistic management of the patient’s condition (Taberna et al., 2020)Fatigue And Weakness In A Perimenopausal Vegetarian Woman Assignment. The next steps are vital to avoid permanent neurological deficits and to allow the lady to regain her strength and health.

References

Cohen, B. (2023). Anemia. In Handbook of Outpatient Medicine (pp. 355-389). Cham: Springer International Publishing. https://link.springer.com/chapter/10.1007/978-3-031-15353-2_18

Simeone, G., Bergamini, M., Verga, M. C., Cuomo, B., D’Antonio, G., Iacono, I. D., … & Caroli, M. (2022). Do vegetarian diets provide adequate nutrient intake during complementary feeding? A systematic review. Nutrients, 14(17), 3591. https://www.mdpi.com/2072-6643/14/17/3591

Taberna, M., Gil Moncayo, F., Jané-Salas, E., Antonio, M., Arribas, L., Vilajosana, E., … & Mesía, R. (2020). The multidisciplinary team (MDT) approach and quality of care. Frontiers in oncology, 10, 85. https://www.frontiersin.org/articles/10.3389/fonc.2020.00085/full Fatigue And Weakness In A Perimenopausal Vegetarian Woman Assignment

FATIGUE AND WEAKNESS, ADULT FEMALE
Chief Complaint
“Fatigue and weakness.”

History of Present Illness
A 52-year-old Caucasian woman presents to her PCP with complaints of increasing fatigue and weakness over the past 3 to 4 months. She is an avid runner and finds it difficult to keep her usual distance or pace. She tried adding a multivitamin to her daily regimen and has been tracking her sleep on an exercise-tracking watch for the past month without significant findings. She does report having some irregularity with her menses over this past year, but her routine gynecologic exam showed no significant concerns and she denies excessive or heavy bleeding. Her gynecologist reportedly told her she is likely in perimenopause after confirming she is not pregnant with an in-office urine hCG, and she has a follow-up appointment scheduled in about 6 weeks. The patient denies any anxiety or depression and reports good social activity. Her diet is vegetarian and reported as well balanced.

Review of Systems
The patient’s ROS is positive for asthenia without anorexia or weight loss and positive for angular cheilosis and increased soreness of tongue and mouth at times, and she does note some mild hair loss and brittle nails. Her ROS is also positive for some dyspnea on exertion and exercise intolerance, and she has some constipation. She denies chest pain or palpitations. The ROS is also negative for abdominal pain, nausea, vomiting, or diarrhea. She denies blood in stools, hematuria, or dysuria. The patient also denies dizziness, blurred vision, headache, anxiety, and depression. She denies fever, chills, and night sweats and has had no significant change in weight or unusual bruising reported Fatigue And Weakness In A Perimenopausal Vegetarian Woman Assignment.

Relevant History
The patient’s history is unremarkable. Her menses are irregular, less frequent for the past 9 months, with her last menstrual period about 8 weeks ago without excessive or heavy bleeding. Her surgical history is significant for one cesarean section at age 28 and appendectomy at age 35.

The patient is married and lives at home with her spouse and youngest child. She is employed as an accountant full-time with a graduate school education. She denies smoking or illicit drug use. She drinks socially, reporting about four to five glasses of wine per week. Her family history includes her mother, aged 76 with hypertension, and father, aged 77 with hyperlipidemia, hypertension, and gout.

Allergies
Fluoroquinolones-rash; no known food allergies.

Medications
•Women’s over-50 multivitamin.

•Ooccasional ibuprofen 400 mg PRN for pain.

Physical Examination
Vitals: T 36°C (96.8°F), P 62, R 14, BP 112/62; HT 170 cm (67 in.), WT 57 kg (126 lbs), BMI 19.4.

General: A&O×3, well groomed.

Psychiatric: Normal affect, pleasant and cooperative.

Skin, Hair, and Nails: Skin dry but without rash or lesions, normal hair distribution, brittle nails Fatigue And Weakness In A Perimenopausal Vegetarian Woman Assignment.

Eye: Mild pallor of conjunctiva.

ENT/Mouth: Evidence of healing angular cheilosis bilaterally with some smoothness and redness of tongue. Mucous membranes with some mild pallor.

Neck: Supple without thyromegaly. Head and neck lymph nodes within normal limits.

Lungs: Clear to auscultation with normal respiratory effort.

Heart: S1S2, RRR; no murmur noted.

Abdomen: Soft, nontender, no distention. No organomegaly. Positive and normal bowel sounds in all quadrants.

Genital/Rectal: No external hemorrhoids, negative for occult blood. Genital exam deferred.

Neurologic: CN II–XII grossly intact with normal patellar deep tendon reflexes. Fatigue And Weakness In A Perimenopausal Vegetarian Woman Assignment

Clinical Discussion Questions
What is the differential diagnosis?
What is the most likely diagnosis? Why?
Demonstrate your understanding about the pathophysiology in regard to the most likely diagnosis.
Should tests/imaging studies be ordered? Which ones? Why? Think about tests/imaging beyond the primary care setting as well.

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What are the next appropriate steps in management?
What are the causes, risk factors, and treatment options for this diagnosis? Provide references for your response.
What are the pertinent ICD-10 and CPT (E/M) codes for this visit? Provide a short rationale.
What is the appropriate patient education for this case?
If not managed appropriately, what is/are the medical/legal concern(s) that may arise?
Think about interprofessional collaboration for this case. Provide a list of specialties or other disciplines and indicate what contribution these professionals might make to managing the patient Fatigue And Weakness In A Perimenopausal Vegetarian Woman Assignment