The patient was closely questioned again. She could not recall any trauma to her right leg. Her main activity regarding the leg was use of the walker. She did not recall any history of bleeding or bruising excessively, even with extensive back surgery.
Regarding her diet, the patient admitted that she has not been eating well; she relates this to her relative immobility, lack of teeth, and GI discomfort over the past 6-12 months. Her diet has mainly consisted of fluids, breads, and other soft foods, cereals and tea. She admits very little intake of fruits, vegetables, or meat.
On closer physical examination, the patient was found to have some hyperkeratotic hair follicles with surrounding hemorrhage. Some of the hairs were coiled and bent.
A diagnostic laboratory test was performed on serum which was drawn at admission and frozen immediately for later lab tests. (answer on page 12)