A 55-year-old non-smoker presents with hemoglobin 18.5 g/dL and hematocrit 56%. Which physical examination finding is most likely?

• A. Splenomegaly
• B. Cheilosis
• C. Purpura
• D. Decreased Vibratory Sense

Answer: (A)

Elevated red cell mass with a high hematocrit in a 55-year-old who is a non-smoker points toward a primary myeloproliferative process rather than a secondary response to hypoxia. In polycythemia vera, the body makes too many red cells, and the spleen often enlarges because of increased blood cell turnover and extramedullary hematopoiesis. Splenomegaly is a common physical finding in PV, reflecting this underlying process.

Cheilosis would suggest a nutritional deficiency rather than a red cell–mass disorder. Purpura points to platelet or vascular issues rather than the blood cell overproduction seen in PV. Decreased vibratory sensation implies a neuropathy (like B12 deficiency) and isn’t a feature of PV. So splenomegaly best fits the scenario given the markedly elevated hemoglobin and hematocrit in a non-smoker.