Rosh Internal Medicine Boost Practice Exam

In a patient with severe menorrhagia and signs of iron deficiency, which additional physical exam finding is most likely?

1. Facial plethora

2. Jaundice

3. Loss of tongue papillae

4. Petechiae

The correct answer is: Loss of tongue papillae

In patients experiencing severe menorrhagia accompanied by signs of iron deficiency, one common physical exam finding is the loss of tongue papillae. This phenomenon occurs due to the impact of chronic iron deficiency on the health of the oral mucosa and specifically the tongue. Iron is essential for various physiological processes, including the maintenance of mucosal integrity. In cases of prolonged iron deficiency, the tongue may exhibit atrophy of the filiform papillae, leading to a smooth appearance known as glossitis. This result is a direct consequence of inadequate iron levels affecting cellular turnover and health. While other options like facial plethora, jaundice, and petechiae might be associated with different hematologic or systemic conditions, they are less specific to the scenario of iron deficiency caused by severe menorrhagia. Facial plethora is often seen in conditions like polycythemia, jaundice indicates liver dysfunction or hemolysis, and petechiae are associated with platelet disorders or clotting factor deficiencies. None of these directly correlate with iron deficiency in the context of menorrhagia as clearly as the loss of tongue papillae does.