A 73-year-old man comes to the office with fatigue that has become progressively worse over the last several months


#1

A 73-year-old man comes to the office with fatigue that has become progressively worse over the last several months. He is also short of breath when he walks up one flight of stairs. He drinks 4 vodka martinis a day. He has numbness and tingling in his feet. On physical examination he has decreased sensation of his feet. His hematocrit is 28% and MCV is 114 fL (elevated). What is the most appropriate next step in management?

  • a-Vitamin B12 level.
  • b-Folate level.
  • c-Peripheral blood smear.
  • d-Schilling test.
  • e-Methylmalonic acid level.

0 voters