Hematology/Oncology Case #1

62-year-old male presents to primary provider’s office with a six-month history of fatigue and gait disturbance.  He denies recent falls, weakness, pain, paralysis, or dizziness.



Lisinopril 10mg daily

Metformin 1000mg BID

Men’s multivitamin

Fish oil


Past Medical History

Diabetes Mellitus II


Gastric cancer


Past Surgical History

Cholecystectomy – 1997

Partial gastrectomy – 2004



BP-128/79, HR-81, RR-14, O2-100%, Temp-98.9o


Physical Exam

General – WN/WD, NAD

Skin – scattered senile purpura, no petechiae

CV – RRR without M/G/R

Pulmonary – CTA bilaterally without adventitial breath sounds

Neurologic – A&Ox3, 5/5 strength throughout bilaterally, DTR 2+ and equal, FROM, vibratory sensation decreased in bilateral lower extremities


Laboratory Studies


Hypersegmented Neutrophils






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