#16: 75 Year-Old Woman with Fatigue and Poor Balance

<p>A 75-year-old woman with diabetes presents with fatigue, pallor, poor balance, and a complaint of a "pins and needles" sensation of her hands and feet. On initial laboratory testing, you determine that she has a macrocytic anemia. How can you distinguish between alcoholism and folate deficiency? How can you distinguish between vitamin&nbsp;B12&nbsp;deficiency and folate deficiency?&nbsp; Name three medications and three medical or surgical causes of vitamin&nbsp;B12&nbsp;deficiency. What is the most common neurologic finding and what is a classic neurologic finding of vitamin&nbsp;B12&nbsp;deficiency?</p>