Question of the Week # 159, 160

Archer USMLE Step 3

159) A 65 year old man with history of Diabetes Mellitus Type II and Hypertension is evaluated for a one month history of numbness in bilateral hands and feet. He has been feeling excessively tired lately. His medications include Glyburide, Metformin and Enalapril for the past 5 years. Physical examination reveals loss of position sensation in bilateral lower extremities.  He reports good control of blood pressure and Diabetes. His recent HgBA1C was 6.0% 1 month ago. His laboratory tests reveal a Hemoglobin of 9.0gm%; WBC of 8.0k/µl, MCV of 103 and Platelets of 200k/µl. Once the diagnosis is confirmed, the most important therapeutic step in addressing this patient’s presentation:

A) Stop Metformin

B) Switch to insulin

C) Vitamin b12 and Calcium supplementation

D) Start Gabapentin

E) Start Thyroid Supplements

160) In Question above, the most likely underlying cause of this patient’s presentation:

A) Diabetes related complications

B) Chronic Metformin Use

C) Poor Glycemic Control

D) Myelodysplastic Syndrome

E) Hypothyroidism 

12 Thoughts on “Question of the Week # 159, 160”

  1. milan on June 25, 2011 at 11:05 pm said:

    c
    b

    Reply↓
  2. stefan on July 14, 2011 at 4:59 am said:

    C) Vitamin b12 and Calcium supplementation

    B) Chronic Metformin Use

    Reply↓
    • Esdra on January 30, 2012 at 3:05 am said:

      A and B are the answer. The pt is experiencing megaloblastic anemia due to chronic use of metformin. The fist thing to do is to stop metformin.

      Reply↓
  3. roy alonso on February 19, 2012 at 6:56 pm said:

    they are not s/e of metformin….she has a megaloblastic anemia, b12 is needed

    Reply↓
  5. %usmle%, %galaxy% via Facebook on February 22, 2012 at 9:07 pm said:

    why would poor glycemic control cause anemia if renal function is adequate? Is it something related to metformin?

    Reply↓
  6. rahul sharma on February 23, 2012 at 6:58 am said:

    C,B
    Chronic metformin use causing malabsorption of vit.B12 in turn causing megaloblastic anemia….

    Reply↓
  7. %usmle%, %galaxy% via Facebook on February 25, 2012 at 4:43 pm said:

    it,s beacuse of poor immunity leading to destruction of RBC,s

    Reply↓
  8. Vj on February 26, 2012 at 4:16 am said:

    The answers are c and b. Metformin induced Vitamin B12 deficiency is because metformin interferes with B12-intrinsic factor complex at the terminal ileum that is calcium dependent. Treatment with B12 and calcium is to be given.

    Reply↓
  9. tim on February 27, 2012 at 7:33 pm said:

    how can it be C…no point of giving vitb12 supplement because it won’t gonna absorb in the presence of metformin…so have to stop metformin first for vitb12 supplement to be absorbed from the intestine.so it shld be A

    Reply↓
  10. Aysar on October 10, 2012 at 5:00 am said:

    http://ageing.oxfordjournals.org/content/35/2/200.full
    B12 & calcium must be given & its because of Metformin use

    Reply↓
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