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MODULE > MOD2 PART1 > Flashcards

MOD2 PART1 Flashcards

1
Q

Which of the following statements regarding folate metabolism is CORRECT?

A. The greatest amount of folate absorption occurs in the distal ileum
B. Hydrolases facilitate the export of absorbed polyglutamyl folate to other cells
C. A large volume of distribution in the body prevents the rapid development of severe folate deficiency
D. Freezing in sub-zero temperatures easily destroys folic acid

A

B. Hydrolases facilitate the export of absorbed polyglutamyl folate to other cells

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2
Q

Which of the following is NOT TRUE about the erythrocyte?

A. The size of the red cell mass reflects the balance of red cell production and destruction
B. Mature RBC is discoid and extremely pliable to traverse the microcirculation successfully
C. The organ responsible for red cell production is called the erythron
D. Membrane integrity of the RBC is highly dependent on extracellular generation of ATP, due to lack of organelles

A

D. Membrane integrity of the RBC is highly dependent on extracellular generation of ATP, due to lack of organelles

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3
Q

This test rises in severe cobalamin deficiency because of the block in conversion of MTH to tetrahydrofolate (THF) inside cells?

A. Red Cell Folate
B. Serum Cobalamin
C. Serum Folate
D. Serum Methylmalonate and Homocysteine

A

C. Serum Folate

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4
Q

What is a physical examination finding in anemic patients with hemoglobin level between 8-10 g/dL?

A. Lighter color in the palmar creases compared to surrounding skin when hyperextended
B. Hypotension
C. Agitation
D. Forceful heartbeat

A

D. Forceful heartbeat

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5
Q

Which of the following is NOT TRUE about erythropoietin?

A. EPO is exclusively produced and released by peritubular capillary lining cells within the kidney
B. The fundamental stimulus for EPO production is the availability of oxygen for tissue metabolic needs
C. Plasma EPO levels increase in proportion to the severity of the anemia
D. EPO acts by binding to specific receptors on the surface of marrow erythroid precursors, inducing them to proliferate and to mature

A

A. EPO is exclusively produced and released by peritubular capillary lining cells within the kidney

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6
Q

TRUE of oxygen affinity of hemoglobin in different situations

A. Increase in 2,3 BPG increases hemoglobin oxygen affinity
B. Hemoglobin has a higher oxygen affinity among patients with hypovolemic shock
C. During pregnancy, there is an expected fall in hemoglobin levels
D. There is better oxygen delivery noted at higher altitudes

A

C. During pregnancy, there is an expected fall in hemoglobin levels
D. There is better oxygen delivery noted

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7
Q

Which of the following is associated with erythropoietin regulation?

A. Body mass index
B. Red cell volume
C. Tissue oxygenation
D. Marrow erythroid

A

C. Tissue oxygenation

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8
Q

What is NOT a key element in erythropoiesis?

A. Erythropoietin production
B. Functional hepcidin
C. Iron
D. Erythroid marrow

A

B. Functional hepcidin

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9
Q

Which of the following is an example of an antifolate drug?

A. Omeprazole
B. Cefuroxime
C. Phenytoin
D. Paracetamol

A

C. Phenytoin

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10
Q

What is the recommended dose of folic acid among women who have had a previous fetus with a neural tube defect and is contemplating pregnancy?

A. 5 µg daily
B. 5 mg daily
C. 400 µg daily
D. 400 mg daily

A

B. 5 mg daily

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11
Q

TRUE about treatment of iron deficiency anemia

A. Oral iron is usually inadequate for asymptomatic patients with established iron-deficiency anemia
B. A patient with sensitivity to one preparation of intravenous iron should not be given any parenteral preparation to avoid prophylaxis
C. Transfusion therapy is reserved for individuals who have symptoms of anemia, cardiovascular instability, and continued and excessive blood loss from whatever source
D. Oral iron supplementation must always be accompanied with oral vitamin C supplementation

A

C. Transfusion therapy is reserved for individuals who have symptoms of anemia, cardiovascular instability, and continued and excessive blood loss from whatever
source

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12
Q

Which of the following statements about the clinical presentation of iron deficiency is NOT TRUE?

A. Koilonychia is a sign of advanced tissue iron deficiency
B. The appearance of iron deficiency in an adult male or post-menopausal female means gastrointestinal blood loss until proven otherwise
C. The diagnosis of iron deficiency is typically based on laboratory results
D. Cheilosis is a sign of early tissue iron deficiency

A

D. Cheilosis is a sign of early tissue iron deficiency

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13
Q

Which of the following drugs is associated with the development of folate deficiency?

A. Nitrofurantoin
B. Colchicine
C. Neomycin
D. Insulin

A

A. Nitrofurantoin

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14
Q

Which of the following conditions is associated with folate deficiency at the time of conception and early stages of pregnancy?

A. Infertility
B. Congenital heart defects
C. Cleft palate
D. Respiratory distress

A

C. Cleft palate

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15
Q

Which of the following is a sign of chronic anemia?

A. Bradycardia
B. Systolic flow murmur
C. Cyanosis
D. Faint peripheral pulses

A

B. Systolic flow murmur

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16
Q

Match the following causes of iron deficiency to their corresponding categories
Menstruation

A. Increased Iron Loss
B. Decreased Iron Intake/Absorption
C. Increased Demand for Iron
D. None of the above

A

A. Increased Iron Loss

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17
Q

Match the following causes of iron deficiency to their corresponding categories
Chronic GI Bleeding

A. Increased Iron Loss
B. Decreased Iron Intake/Absorption
C. Increased Demand for Iron
D. None of the above

A

A. Increased Iron Loss

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18
Q

Match the following causes of iron deficiency to their corresponding categories
Crohn’s Disease

A. Increased Iron Loss
B. Decreased Iron Intake/Absorption
C. Increased Demand for Iron
D. None of the above

A

B. Decreased Iron Intake/Absorption

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19
Q

Match the following causes of iron deficiency to their corresponding categories
Pregnancy

A. Increased Iron Loss
B. Decreased Iron Intake/Absorption
C. Increased Demand for Iron
D. None of the above

A

C. Increased Demand for Iron

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20
Q

Match the following causes of iron deficiency to their corresponding categories
Bariatric Surgery

A. Increased Iron Loss
B. Decreased Iron Intake/Absorption
C. Increased Demand for Iron
D. None of the above

A

B. Decreased Iron Intake/Absorption

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21
Q

Which among these causes of cobalamin deficiency may be severe enough to cause megaloblastic anemia?

A. Total gastrectomy
B. HIV infection
C. Zollinger-Ellison syndrome
D. Pancreatitis

A

A. Total gastrectomy

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22
Q

What would be the level of hemoglobin if pallor is noted on the palmar creases of a patient, who complained of dizziness and easy fatigability? It is likely less than

A. 6 g/dL
B. 7 g/dL
C. 8 g/dL
D. 9 g/dL

A

C. 8 g/dL

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23
Q

Which of the following describes patients with megaloblastic anemia?

A. A patient presenting with marked weight gain and increased appetite
B. A male patient complaining of paresthesias, muscle weakness, and visual impairment
C. A female patient, without subjective complaints during a routine annual physical examination, presenting with decreased MCV in her CBC results
D. Cognitive impairment and changes in sensorium in a patient with recent alcohol use at a friend’s birthday party

A

B. A male patient complaining of paresthesias, muscle weakness, and visual impairment

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24
Q

Which of the following is accurate regarding the absorption of vitamin B12?

A. In the ileum, bound vitamin B12 is released from haptocorrin by the action of pancreatic proteases and associated with intrinsic factor
B. Vitamin B12 is freed from binding proteins in food through the action of haptocorrin in the stomach and binds to a salivary protein
C. Within ileal cells, vitamin B12 associated with a major carrier protein, transcobalamin II
D. Ileal enterocytes express a receptor for intrinsic factorB called haptocorrin

A

C. Within ileal cells, vitamin B12 associated with a major carrier protein, transcobalamin II

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25
Q

Which of the given laboratory results does not support the diagnosis of iron deficiency anemia?

A. Low Hgb
B. Low MCHC
C. Low serum iron
D. Low transferrin

A

D. Low transferrin

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26
Q

Which of the following is not a clinical feature of folate deficiency?

A. Spooning of the fingernails
B. Anorexia
C. Weight loss
D. Reversible melanin skin hyperpigmentation

A

A. Spooning of the fingernails

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27
Q

Cite one drug that interferes in folic acid utilization by impairing nutrient absorption thus, precipitating
pernicious anemia:

A. Methotrexate
B. Carbamazepine
C. Penicillin
D. Propylthiouracil
E. Phenytoin

A

E. Phenytoin

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28
Q

Which condition will increase the demand for iron?

A. Menstruation
B. Pregnancy
C. Chronic inflammation
D. Chron’s disease

A

B. Pregnancy

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29
Q

Which of the following is true regarding reticulocyte response in anemia?

A. Reticulocyte count reflects the marrow response only if the EPO stimulation is adequate
B. Premature release of reticulocytes is normally due to EPO stimulation
C. At normal hemoglobin, reticulocytes are released to the circulation with ~2 days left as reticulocytes
D. With established anemia, a reticulocyte response less than 2-3x normal indicates an adequate marrow response

A

B. Premature release of reticulocytes is normally due to EPO stimulation

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30
Q

Which of the following manifestations coincide with the detrimental tissue effects of severe Cobalamin/Folate deficiencies?

A. Parkinson’s disease
B. Respiratory distress due to Pulmonary Fibrosis
C. Central neuropathy by vertebral degeneration
D. Neural tube defects

A

D. Neural tube defects

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31
Q

Before large doses of folic acid are given in a patient with megaloblastic anemia, cobalamin deficiency must be excluded and, if present, corrected because there is a risk for the development of which of the following conditions?

A. Bone marrow failure
B. Liver failure
C. Neuropathy
D. Cardiomyopathy

A

C. Neuropathy

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32
Q

Which of these parameters does NOT follow the pattern of anemia of acute inflammation?

A. Normal % transferrin saturation
B. Normal serum ferritin
C. Low TIBC
D. Low serum iron

A

A. Normal % transferrin saturation

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33
Q

In patients with Cobalamin deficiency enough to cause anemia or neuropathy, which of the following diagnostic results is expected?

A. Elevated Pepsinogen 1
B. Elevated Homocysteine levels
C. Low Methylmalonic acid levels
D. Low serum gastrin

A

B. Elevated Homocysteine levels

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34
Q

Which of the following tests is indicated for patients with Megaloblastic Anemia?

A. Colonic biopsy
B. Imaging with contrast
C. Laparoscopy
D. Gastric endoscopy

A

D. Gastric endoscopy

35
Q

What is the primary regulatory hormone for RBC production?

A. VEGF
B. EPO
C. FOG-1
D. GATA-1

A

B. EPO

36
Q

Bone marrow aspiration for cytology is indicated for which situation?

A. Hypoproliferative anemia with noted low serum ferritin
B. Patient with noted hemoglobinopathy
C. Maturation disorder anemia with noted vitamin B12 deficiency
D. Hypoproliferative anemia with normal iron studies

A

D. Hypoproliferative anemia with normal iron studies

37
Q

A 15-year-old boy on a strict vegetarian diet presented with ictericia and splenomegaly. Laboratory results showed hemoglobin of 8 g/dL, MCV of 116 fL, platelet of 140,000/mm3. Chest radiograph was unremarkable. Vitamin B12 level was 90 ng/mL, Folic acid level was 10 ng/mL. What is the most appropriate medical intervention for this patient?

A. Fresh whole blood transfusion, 2 units, in the next 48hrs
B. Intramuscular cyanocobalamin injections
C. Oral folic acid 1 mg OD
D. Oral iron ferrous glycine sulfate; 4 mg/kg/day of elemental iron

A

B. Intramuscular cyanocobalamin injections

38
Q

Which of the following is true regarding hypoproliferative anemia?

A. Reflects absolute or relative marrow failure
B. Characterized by microcytic and normochromic anemia
C. Usually has evident blood loss or hemolysis
D. Occurs in 80% cases of anemia

A

A. Reflects absolute or relative marrow failure

39
Q

Which of the following statements is TRUE regarding the physiologic regulation of erythropoiesis?

A. With EPO stimulation, RBC production can increase four-to-fivefold within 5 days, especially in the presence of adequate iron
B. The fundamental stimulus for EPO production is the availability of CO2 for tissue metabolic needs
C. A small amount of EPO is produced by hepatocytes
D. In the circulation, EPO has a half-clearance time of 12-24 hours.

A

C. A small amount of EPO is produced by hepatocytes

40
Q

Which of the following drugs is most active against the bacterial DHF reductase and is likely to cause megaloblastic anemia when used in conjunction with sulfamethoxazole?

A. Folinic acid
B. Trimethoprim
C. Methotrexate
D. Phenytoin

A

B. Trimethoprim

41
Q

Folate is involved in numerous reactions in the body. Cobalamin, on the other hand, is essential in only 2 reactions, one of which is:

A. Methylation of homocysteine to methionine
B. Methylation of homocysteine to Sadenosylhomocysteine
C. Phosphorylation of methionine to SAM
D. Reduction of 5,10 methylenetetrahydrofolate to 5-
methyltetrahydrofolate

A

A. Methylation of homocysteine to methionine

42
Q

A 40-year-old male came in due to history of 2 weeks history of melena associated with dizziness and pallor. He was brought at the ER and advised admission. Which of the following is true?

A. CBC will demonstrate microcytic, hypochromic anemia
B. Bone marrow examination is warranted
C. Peripheral blood smear will show macrocytosis
D. Reticulocyte count is expected to be elevated

A

D. Reticulocyte count is expected to be elevated

43
Q

Mr. M, a 62-year-old male with congestive heart failure, came to your clinic due to anemia. He is fairly asymptomatic with only occasional episodes of effort related shortness of breath. He maintains wellbalanced diet with meat, fish and greens. His CBC shows:
Hemoglobin 9.5 gm/dL
Hematocrit 28.5%
RBC 4.0 mil/mm3
WBC 9,800/mm3 (N 65, L 35)
Platelet 350,000/mm3
MCV 120 fL
MCH 28 pg
MCHC 32%
What is the most likely cause of this nutritional anemia?

A. Cobalamin deficiency
B. Folate deficiency
C. Iron deficiency
D. Any 2 of these conditions

A

B. Folate deficiency

44
Q

Which of the following abnormally shaped red blood cells is less likely to be seen in the blood smears of an iron deficiency anemia?

A. Stomatocytes
B. Echinocytes
C. Codocytes
D. Ovalocytes
E. Elliptocytes

A

B. Echinocytes

45
Q

Which of the following statements is TRUE regarding the tests for iron supply and storage?

A. A nocturnal variation in the serum iron leads to a variation in the percent transferrin saturation.
B. Adult males have a lower serum ferritin level averaging 30 ug/L, reflecting lower iron stores.
C. The percent transferrin saturation is derived by dividing the serum iron level (x100) by the TIBC.
D. A serum ferritin level of 30-50 ug/L indicates depletion of iron stores.

A

C. The percent transferrin saturation is derived by dividing the serum iron level (x100) by the TIBC.

46
Q

Which of the following is characteristic of the 2nd stage of Iron deficiency anemia?

A. Serum Iron < 30 ug/dL
B. RBC Protoporphyrin > 100 ug/dL
C. TIBC > 400 ug/dL
D. Serum ferritin < 30 ug/dL

A

B. RBC Protoporphyrin > 100 ug/dL

47
Q

Which of the following is a malabsorption condition that causes Cobalamin deficiency?

A. Total Gastrectomy
B. Pernicious Anemia
C. Chron’s Disease
D. Tropical Sprue

A

B. Pernicious Anemia

48
Q

A 36/F patient was seen at the OPD clinic with pallor and shortness of breath. She was also noted to have fissures at the corners of her mouth and spooning of her fingernail. This is commonly seen among:

A. Acute causes of anemia such as blood loss or hemolysis
B. Chronic cases of megaloblastic anemia with folate deficiency
C. Chronic cases of iron deficiency anemia
D. All of these cases

A

C. Chronic cases of iron deficiency anemia

49
Q

Which of the following is true when correcting Iron Deficiency Anemia?

A. Oral iron preparation should be taken on an empty stomach
B. 200 mg dose of supplemental iron per day should result in absorption of iron up to 50mg/day
C. The goal of therapy is to correct anemia and to provide stores of at least 0.5g of iron
D. All of the above

A

D. All of the above

50
Q

Which of the following causes of Megaloblastic Anemia is refractory to cobalamin and folate therapy?

A. Myelodysplasia
B. Pregnancy
C. Tropical Sprue
D. Congenital absence of intrinsic factor

A

A. Myelodysplasia

51
Q

The following is/are indications for red cell transfusion:

A. Excessive blood loss with presence of hypotension
B. Pallor, hemoglobin of 6, and has been complaining of easy fatigability and dizziness
C. Both A and B
D. None of the above

A

A. Excessive blood loss with presence of hypotension
B. Pallor, hemoglobin of 6, and has been complaining of easy fatigability and dizziness

52
Q

Which of the following refers to the primary regulatory factor needed for red cell production and maintenance of progenitor cell

A. Erythron
B. Erythroid marrow
C. Erythroid
D. Erythropoietin

A

D. Erythropoietin

53
Q
  1. A 35 yr old woman, 2nd trimester came in for fatigue. No previous prenatal checkups, no supplements taken. PE: pale conjuntiva,
    spooning of nails, G2 systolic murmur in left sternal border.
    CBC:
    Hgb-7.1
    Hct-23%
    WBC-5400
    Platelet- 450k
    MCV-74
    RDW-17.1
    Which of the ff will help in thorough investigation

A. serum ferritin is high
B. retic count is less than 2.5
C. MCHC is increased
D. TIBC is decreased

A

B. retic count is less than 2.5

54
Q

A careful and thorough history and PE is essential in the evaluation of a patient with anemia. Which of the following statements regarding anemia and relevant clinical findings is correct

A. G6PD deficiency and anemia is predominant in Asians
B. Anemia with Petechiae indicates platelet dysfunction
C. Anemia with Hepatomegaly and associatedNthrombocytopenia is indicative of malignancy
D. Patient diagnosed with anemia will need to work up for hemolytic anemia

A

A. G6PD deficiency and anemia is predominant in Asians

55
Q

A 28/F was referred to your clinic for work-up of anemia. She was found out to be anemic after a routine pre-employment check-up. She complained of occasional exertional dyspnea but denied other symptoms. PE was unremarkable. What laboratory test is key for the classification of the patient’s anemia

A. MCV
B. Reticulocyte count
C. Serum ferritin level
D. RDW

A

B. Reticulocyte count

56
Q

Which of the following findings in the peripheral blood smear signifies a high number of red blood cells in the bloodstream as a result of premature release from the marrow

A. Poikilocytosis
B. Anisocytosis
C. Polychromasia
D. Hypochromia

A

C. Polychromasia

57
Q

A 45 yr old female with a CBC that includes microcytic and hypochromic anemia with a reticulocyte index of 1.8%. What is the LEAST diagnosis?

A. Thalassemia
B. Iron Deficiency Anemia
C. Sideroblastic Anemia
D. Autoimmune Hemolytic Anemia

A

D. Autoimmune Hemolytic Anemia

58
Q

Which of the ff conditions is consistent with the finding of reticulocyte index of <1.9 and macrocytic red cell morphology

A. G6PD deficiency
B. Megaloblastic anemia
C. Acute Inflammation
D. Chronic Kidney Disease

A

B. Megaloblastic anemia

59
Q

Which of the ff would lead to microcytic hypochromic anemia?

A. Alcoholism
B. Chronic Kidney Disease
C. Pernicious Anemia
D. Hookworm infestation

A

D. Hookworm infestation

60
Q

Which of the following is TRUE of nuclear maturation defects in the marrow?

A. May arise from abnormalities in globin or heme synthesis
B. Presence of microcytosis in peripheral blood smear
C. Reticulocyte production index >2.5
D. May be secondary to drug use (methotrexate or alkylating
agents)

A

D. May be secondary to drug use (methotrexate or alkylating
agents)

61
Q

Which of the following laboratory values is indicative if anemia of acute or chronic inflammation

A. Low serum iron, Low TIBC, low ferritin
B. Low serum iron, Low TIBC, high ferritin
C. Low serum iron, High TIBC, low ferritin
D. Low serum iron, High TIBC, high ferritin

A

B. Low serum iron, Low TIBC, high ferritin

62
Q

A patient found to have hypoproliferative anemia and a normal iron level. What is warranted to this patient?

A. Bone marrow aspirate
B. Electrophoresis
C. Serum erythropoietin
D. Thyroid function test

A

A. Bone marrow aspirate

63
Q

Which of the following peripheral blood smears shows in megaloblastic anemia?

A. oval macrocytic w/ hypersegmented neutrophils
B. microcytic & hypochromic
C. pancytopenia
D. nucleated red cell w/ giant platelets

A

A. oval macrocytic w/ hypersegmented neutrophils

64
Q

Which of the following increases demands for iron?

A. Blood Transfusion
B. EPO Therapy
C. Menses
D. Acute Blood Loss

A

B. EPO Therapy

65
Q

In iron deficiency anemia, which of the following laboratory parameters increases as serum iron levels decrease?

A. Marrow sideroblasts
B. RBC protoporphyrin
C. Transferrin saturation
D. Peripheral smear sideroblasts

A

B. RBC protoporphyrin

66
Q

Janeeela Ma Rice came to the clinic for because of her profuse menses, she can use up to 10 maxi pads a day. You requested for laboratory, these are the results:
WBC 5500
Hgb 12.5 (normal)
Hct 38 (normal)
Platelet count 276 000
TIBC: 400 (increased)
Ferritin: 12ug/dL (decreased)
IRON: 30 ug/dL (decreased)
Retic count 1% (normal)
Peripheral smear: Mild anisocytosis with few RBCs noted to be microcytic. WBC and platelets are adequate. No blasts
Which of the following stages of iron deficiency anemia is the patient in?

A. Negative iron balance
B. Iron deficient erythropoiesis
C. Iron deficiency anemia
D. Normal since the patient is not anemic

A

B. Iron deficient erythropoiesis

67
Q

Which of the ff is the sign of advance tissue iron deficiency?

A. Reduced exercise capacity
B. Easy fatigability
C. Low serum ferritin levels
D. Cheilosis

A

D. Cheilosis

68
Q

Ethel boobita 35 year old, Increased fatigue nothing else
WBC 7500
Hbg7.5
Hematocrit 23
platelet count 111,000
Retic count 1.5%
serum transferrin 200
TIBC 250
SI 40
Sat % 16%
Anisocytosis,normochromic, normal sized RBS, WBC is okay.
What is the most likely cause of Ethel’s anemia?

A. Iron deficiency
B. Thalassemia
C. Inflammation
D. Myelodysplastic syndrome

A

C. Inflammation

69
Q

How many mg of elemental iron are there in one 325mg tablet of Ferrous fumarate?

A. 39
B. 65
C. 100
D. 107

A

D. 107

70
Q

Your mom was recently diagnosed with Iron Deficiency Anemia. You prescribed her with ferrous sulfate 325mg cap PO TID to correct her iron deficiency. Her current Hgb is 9.8g/dL. She asks you if she needs to take the medication for life. The most appropriate response would be to take ferrous sulfate:

A. For life, regardless of Hgb levels
B. Until her Hgb reaches 12g/dL then maintain at once daily
C. Until her Hgb reaches 12g/dL then discontinue medication
afterwards
D. Unti her Hgb reached 12g/dL then continue treatment for at least 6 months

A

D. Unti her Hgb reached 12g/dL then continue treatment for at least 6 months

71
Q

Julia Montez had her 1st child via normal spontaneous vaginal delivery. Weighed 45kg post-partum. Claimed she only lost 500ml of blood but Hgb showed 10g/dl from baseline of 11.5g/dl. She is asymptomatic and able to ambulate. Decide to give her 500mg of iron supplement to replenish lost iron but she vomits citing burning pain. What is the most appropriate next step to take?

A. Give oral iron supplement together with antacid to lessen gastric irritation
B. Administer iron sucrose 100mg mixed with 50cc D5W to run for 90 mins as IV drip weekly for 10 weeks
C. 1 vial of LMW iron dextran(1500mg) mixed with 100cc D5W to run for 60 mins as IV drip for 1 dose
D. 2 vials of feromoxytol (510mg/vial) mixed with 250cc D5W to run for 90mins as IV drip for 1 dose

A

D. 2 vials of feromoxytol (510mg/vial) mixed with 250cc D5W to run for 90mins as IV drip for 1 dose

72
Q

Which of the following associations is incorrectly paired?

A. Haptocorrin - saliva
B. IF - fundus
C. Cubilin - duodenum
D. Transcobalamin II - ileum

A

C. Cubilin - duodenum

73
Q

Which of the ff statement about folate metabolism si correct?

A. folate daily intake 400mg
B. diet devoid of folate will develop anemia within a week
C. folate form is polyglutamate
D. serum folate is determined entirely by albumin

A

A. folate daily intake 400mg

74
Q

Cobalamin deficiency can lead to fall of intracellular folate level due to

A. Decreased activity of polyglutamate synthase by falling folate level
B. Specificity of polyglutamate synthase to tetrahydrofolate
C. Cobalamin dependent activity of dihydrofolate reductase
D. All of the above

A

B. Specificity of polyglutamate synthase to tetrahydrofolate

75
Q

Psychiatric symptoms in cobalamin deficiency is attributed to impaired:

A. DNA synthesis
B. Methyltetrahydrofolate synthesis
C. Homocysteine synthesis
D. Metabolism of neurotransmitters

A

D. Metabolism of neurotransmitters

76
Q

Which of the following needs a life long folate medication?

A. 50 y.o female on dialysis
B. 5 y.o boy with G6PD
C. 20 y.o asymptomatic male with gluten free diet

A

A. 50 y.o female on dialysis

77
Q

Which of the following will need a prophylactic dose of folic acid?

A. Post term babies
B. Women in their reproductive years
C. Children in malaria endemic areas
D. Elderly with cardiovascular disease

A

B. Women in their reproductive years

78
Q

NOT TRUE of megaloblastic anemia.

A. Marrow is hypocellular
B. Anemia is based of ineffective erythropoiesis
C. Requires both cobalamin and folate deficiency
D. Genetic/acquired abnormalities

A

A. Marrow is hypocellular

79
Q

We are able to treat pernicious anemia with large amounts of oral cobalamin because?

A. Transcobalamin II in ileal cells delivers Vit B12 to liver and or other cells
B. Parietal cells in stomach fundal cells aid in absorption
C. Alternative uptake mechanism that is independent of intrinsic factor
D. Bound Vit B12 is released from haptocorrin and binds with
IF in the duodenum

A

C. Alternative uptake mechanism that is independent of intrinsic factor

80
Q

Cause of bruising in patient with megaloblastic anemia

A. Low leukocyte count
B. Reversible melanin pigmentation
C. Impaired bactericidal action of phagocytes
D. Thrombocytopenia aggravated with Vit C deficiency

A

D. Thrombocytopenia aggravated with Vit C deficiency

81
Q

Which one of the ff patients does not have a Cobalamin Deficiency?

A. 27 yrs old female on vegan diet with 160ng/L of serum cobalamin
B. A 30 yrs old pregnant woman with 100ng/L of serum cobalamin
C. A 45 yrs old Buddhist monk with 150ng/L of serum cobalamin
D. A 32 yrs old male with 140ng/L of serum cobalamin

A

A. 27 yrs old female on vegan diet with 160ng/L of serum cobalamin

82
Q

A 35 y/o female consulted with her obstetrician because she wants to get pregnant again. Her first child has neural tube defect. What is the MOST APPROPRIATE advice for this patient?

A. Take 5mg folic acid immediately
B. Take 5mg folice acid when trying to get pregnant
C. Wait 6-12 months and don’t get pregnant
D. Get screened for folic acid deficiency, then take
supplements if needed

A

A. Take 5mg folic acid immediately

83
Q

Which of the following is NOT CORRECT about the management of cobalamine deficiency?

A. Patients who have developed cobalamin deficiency may need injection with cobalamin for life
B. Cobalamin should be routinely given to all patients who have had total gastrectomy or ileal resection
C. Patients receiving long-term treatment with proton pump inhibitors may need cobalamin replacement
D. Patients who have undergone gastric reduction for control of obesity will not need cobalamin replacement

A

D. Patients who have undergone gastric reduction for control of obesity will not need cobalamin replacement

MODULE (9 decks)

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