USMLE® Step 1 style questions USMLE
A 35-year-old woman presents to her provider’s office for evaluation of fatigue and exercise intolerance that began two months ago. Past medical history is notable for Crohn disease diagnosed eight-years ago. She is taking mesalamine but reports frequent “flare-ups.” The patient consumes 3-4 glasses of wine per week. Her temperature is 36.9°C (98.4°F), blood pressure is 123/76 mmHg, pulse is 75/min, and respiratory rate is 12/min. The patient has conjunctival pallor. Cardiac, pulmonary, and abdominal examinations are non-contributory. Neurological examination reveals decreased proprioception and vibratory sensation in the lower extremities. Complete blood count reveals a hemoglobin of 8.8 g/dL and a mean corpuscular volume (MCV) of 115 µm3. Which of the following findings would be most likely present in this patient?
Megaloblastic anemia exam links
Megaloblastic anemia is a type of anemia caused by deficiencies in folic acid (folate) or vitamin B12. Folic acid and vitamin B12 are essential for DNA synthesis, and thus the production of healthy red blood cells. Megaloblastic anemia is characterized by large, nucleated red blood cell precursors which don't divide and produce more red blood cells as normal precursor cells do. Symptoms include fatigue, shortness of breath, and pale skin.