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  #1  
Old 02-08-2012
tyagee's Avatar
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Default most likely dx

A 68-year-old patient presents to her primary
care practice complaining of easy fatigue and
shortness of breath over the past year. Six
months ago, her identical twin died of an in-
tracranial hemorrhage. Her history is notable
only for recurrent epistaxis. She is postmeno-
pausal and takes an iron supplement. She
claims she is eating well, sleeping well, and is
at peace with her sisterís passing. Physical ex-
amination reveals the lesions shown in the im-
age and pale conjunctiva. Which of the follow-
ing is the most likely cause of this womanís
symptoms?
(A) Chronic obstructive pulmonary disease
(B) Depression
(C) Gastrointestinal bleeding
(D) Intracranial aneurysm
(E) New onset coronary artery disease
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  #2  
Old 02-08-2012
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Looks like HHT (epistaxis history and lesions in picture)... So GI bleeding leading to iron def anemia and causing pale conjunctiva and shortness of breath and fatigue for an year...
So my answer...C
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  #3  
Old 02-08-2012
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looks like C too.... she is already on Fe, but u can absorb only a limited amount of iron.....
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  #4  
Old 02-08-2012
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I m with c too
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  #5  
Old 02-08-2012
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i think its C......GI bleeding....perioral pigmentation- im suspecting peutz jehgers syndrome..?????????? not confident on this syndrome
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Matched!!!
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  #6  
Old 02-08-2012
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its HHT coz of +ve family history+epistaxis+telangiectasia seen on face
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