Patient I
A 65-year-old female presents to your office with a chief complaint of increasing numbness and tingling
in her fingers, and states, “I am concerned my memory is not as sharp as it was” for the past 6 weeks.
Upon examination, you note pale conjunctiva, beefy red tongue, and a grade III/IV systolic ejection
murmur.
CBC results
• Hgb- 10.2 g/dl
• Hct- 34.5%
• RBC- 3.2 million cells/ µL
• RDW- 20%
• MCV- 126 fl
• MCH- 31 pg
Questions
1. What history of present illness questions do you want to ask of this patient?
2. What further tests would you consider ordering?
3. What is the likely cause of the anemia?
4. The heart murmur noted is a new finding today. How would you explain the etiology of the
heart murmur to your patient?
5. What is your treatment and education plan for this patient?