A 74-year-old man reports several months of fatigue and burning of his feet. He has a smooth, sore tongue and impaired vibration sense at both ankles. His haemoglobin is 92 g/L (130–180), mean cell volume 119 fL (80–100), serum vitamin B12 is 74 pmol/L (140–700), folate is normal and liver and thyroid tests are unremarkable. Antibodies to intrinsic factor are detected. Which one of the following is the most likely diagnosis?
Keep going — a set of ten like this one, one at a time.
Practise moreMore from AMC
See allA 46-year-old woman presents with fatigue, jaundice and dark urine that began after a respiratory infection. She has mild splenomegaly but no renal or neurologi…
Clinical rotations · common
A 35-year-old woman presents with bruising, gum bleeding and increasing lethargy. Her haemoglobin is 84 g/L (115–155), platelet count 18 × 10^9/L (150–400), whi…
Clinical rotations · middle twist
A 27-year-old woman has painless enlargement of the left side of her neck and drenching night sweats. She has no sore throat, dental symptoms or recent travel.…
Clinical rotations · common
A 29-year-old man presents with fever, bruising and aching in the long bones. He has pallor, scattered petechiae and a spleen palpable 2 cm below the costal mar…
Clinical rotations · middle twist
A 32-year-old woman presents seven days after an uncomplicated delivery with five sudden, severe headaches over 48 hours. Each begins abruptly during bathing or…
Clinical rotations · middle twist