Fatigue in the Elderly

In Episode 71 of Med School Question of the Week for USMLE, Hussain Rao, MedSchoolCoach expert tutor, answers this medical school question: A 72-year old man comes into the clinic with a chief complaint of fatigue. He states that he has been increasingly fatigued over the past few months. He thinks that this is a result of old age. He states that his diet has been somewhat irregular recently as well. He states he has been having strange cravings and feels like his diet has become less nutritious recently. He denies any chest pain, vomiting, diarrhea, or weight loss. He has a past medical history significant for hypertension, hyperlipidemia and peripheral arterial disease. Physical exam reveal a 1/6 ejection murmur at the right upper sternal border and pale mucous membranes. Laboratory results are normal except for hemoglobin level of 8.1 and an MCV of 77. Which of the following is the most appropriate next step in the management of this patient?

• Reassurance
• Nutrition/diet log for the next 6 weeks
• Hemoglobin electrophoresis analysis
• Bone marrow biopsy
• Endoscopic evaluation