Which physical exam finding is most likely to be present in a patient with iron deficiency anemia who has a history of menorrhagia?

In the context of iron deficiency anemia, particularly in a patient with a history of menorrhagia, the most relevant physical exam finding would be the loss of tongue papillae. This occurs because iron is essential for various bodily functions, including the maintenance of normal cell turnover and the health of mucosal tissues, such as those found on the tongue.

When iron levels are depleted, the papillae on the tongue can atrophy, leading to a smooth appearance of the tongue known as atrophic glossitis. This characteristic finding can be assessed during a physical examination and is often indicative of chronic iron deficiency. The presence of menorrhagia in this scenario suggests a potential source of chronic blood loss, further enhancing the likelihood of iron deficiency and its related mucosal changes.

In contrast, other findings such as facial plethora, jaundice, and petechiae do not typically correlate directly with iron deficiency anemia. Facial plethora may indicate polycythemia or other hematologic conditions, jaundice reflects liver dysfunction or hemolysis, and petechiae are associated with thrombocytopenia or clotting disorders. Hence, the loss of tongue papillae is the most expected finding in this specific context.