More Than Five Lobes in Medicine / Internal Medicine — 60yo Man | Hematology | SMLE Q#17160
SMLE Question #17160
Medicine / Internal Medicine
Hematology
Objective: OBJ-101
Last updated: February 2026
A 60-year-old man has 3 months of progressive fatigue and unsteady gait. He reports distal numbness and a sore tongue. He follows a strict vegan diet and has autoimmune thyroid disease. Examination shows smooth erythematous glossitis and reduced vibration sense in both legs. Peripheral smear shows macro-ovalocytes and neutrophils with more than five lobes. What is the most likely diagnosis?
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