Megaloblastic anemia Quiz: Ace Your Exams

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A 75-year-old man comes to his primary care physician for a routine visit. Five months ago, his wife died from a stroke. The patient reports feeling depressed, and he has been consuming large quantities of vodka on a daily basis. He previously ate a balanced diet. However, he has had little motivation to cook since his wife passed away, and he currently eats crackers and beef jerky purchased from a convenience store. His temperature is 37.2°C (99.0°F), blood pressure is 117/81 mmHg, pulse is 71/min, and respiratory rate is 12/min. Complete blood count reveals a hemoglobin of 9.2 g/dL and a mean corpuscular volume (MCV) of 110 µm3. A peripheral smear is ordered and the results are as follow:  



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Which of the following is the most likely explanation for this patient's findings?  

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