#july2020mccqe1
A 60-year-old man comes to his physician with complaints of easy fatigability and palpitations for the past 6 months. Physical examination is remarkable for pallor of skin and mucous membranes. No evidence of cardiac or respiratory disease is found. Hematologic studies show:
Hemoglobin 8.4 g/dL
Mean corpuscular volume (MCV) 75 fl
Leukocyte count 9000/mm3
Platelet count 380,000/mm3
Serum chemistry studies show a ferritin of 25 ng/L and serum bilirubin within normal values. Peripheral blood smear shows small erythrocytes with marked variability in size. Which of the following is the most appropriate next step in management?
(A) Bone marrow biopsy
(B) Coombs test for anti-red blood cell antibodies
(C) Hemoglobin electrophoresis
(D) Test for occult blood in the stool
(E) Therapeutic trial with oral ferrous sulfate
(F) Treatment with vitamin B12 and folic acid
A 60-year-old man comes to his physician with complaints of easy fatigability and palpitations for the past 6 months. Physical examination is remarkable for pallor of skin and mucous membranes. No evidence of cardiac or respiratory disease is found. Hematologic studies show:
Hemoglobin 8.4 g/dL
Mean corpuscular volume (MCV) 75 fl
Leukocyte count 9000/mm3
Platelet count 380,000/mm3
Serum chemistry studies show a ferritin of 25 ng/L and serum bilirubin within normal values. Peripheral blood smear shows small erythrocytes with marked variability in size. Which of the following is the most appropriate next step in management?
(A) Bone marrow biopsy
(B) Coombs test for anti-red blood cell antibodies
(C) Hemoglobin electrophoresis
(D) Test for occult blood in the stool
(E) Therapeutic trial with oral ferrous sulfate
(F) Treatment with vitamin B12 and folic acid
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