question: Q:A 25-year-old woman presents to her primary care provider for fatigue. She states that she has felt fatigued for the past 6 months and has tried multiple diets and sleep schedules to improve her condition, but none have succeeded. She has no significant past medical history. She is currently taking a multivitamin, folate, B12, iron, fish oil, whey protein, baby aspirin, copper, and krill oil. Her temperature is 98.8°F (37.1°C), blood pressure is 107/58 mmHg, pulse is 90/min, respirations are 13/min, and oxygen saturation is 98% on room air. Laboratory values are as seen below.
  
  Hemoglobin: 8 g/dL
  Hematocrit: 24%
  Leukocyte count: 6,500/mm^3 with normal differential
  Platelet count: 147,000/mm^3
  
  Physical exam is notable for decreased proprioception in the lower extremities and 4/5 strength in the patient's upper and lower extremities. Which of the following is the best next step in management to confirm the diagnosis?? 
  {'A': 'Anti-intrinsic factor antibodies', 'B': 'Bone marrow biopsy', 'C': 'Homocysteine level', 'D': 'Iron level', 'E': 'Transferrin level'},