Question 1

Which of the following is normal in patients with pernicious anemia (PA)?&#10;A)trypsin levels&#10;B)intrinsic factor (IF)&#10;C)stomach acid&#10;D)absorption of vitamin B12

Accepted Answer

Trypsin is normal in patients with PA.The root cause of PA is a deficiency of IF because of autoimmune attack,either of IF itself or of the parietal cells in which it is synthesized.Atrophic gastritis develops;this affects the secretion of H⁺,which affects gastric (stomach)acidity,important for normal digestive processes.

Question 2

Which of the following is not associated with macrocytic red cells?&#10;A)liver disease&#10;B)iron deficiency anemia&#10;C)megaloblastic anemia&#10;D)myelodysplastic syndrome

Accepted Answer

Iron deficiency is associated with microcytic,not macrocytic,red cells.All the other conditions listed can be associated with macrocytic red cells.

Question 3

Which of the following would be an unusual finding in megaloblastic anemia?&#10;A)marked polychromasia on the blood film&#10;B)hypersegmented neutrophils&#10;C)oval macrocytes&#10;D)pancytopenia

Accepted Answer

Ineffective erythropoiesis leads to intracellular death so that many red cells never make it to circulation;thus polychromasia is not typical.However,hypersegmented neutrophils are a hallmark and,in fact,appear before changes in red cells are obvious.This is because of their short T₁/₂ of 6 to 10 hours in circulation.Oval macrocytes are a characteristic red cell shape in the megaloblastic anemias,and pancytopenia is usually present because all proliferating blood-forming cells in the bone marrow require normal DNA synthesis.

Question 4

Patients with vitamin B&#8321;&#8322; or folate deficiency commonly experience symptoms related to&#10;A)gastrointestinal and neurologic systems.&#10;B)liver and lymph node enlargement.&#10;C)skeletal and muscle problems.&#10;D)kidney and bladder infections.

Accepted Answer

Any system in the body that depends on replacement of cells with new ones will be affected by a deficiency of vitamin B₁₂ or folate.Symptoms of the deficiency can thus be seen in the gastrointestinal tract,the skin,and the hematopoietic system.

Question 5

Methotrexate and some other chemotherapeutic drugs work by&#10;A)killing cancer cells with immune complexes.&#10;B)competing with folate.&#10;C)enhancing folate.&#10;D)inhibiting vitamin B12 absorption.

Accepted Answer

Methotrexate and some other chemotherapeutic drugs work by competing with folate;thus a megaloblastic anemia can develop in these patients.

Question 6

Why are the red cells larger than normal in megaloblastic anemia?&#10;A)Concentration of erythropoietin is increased.&#10;B)Release of reticulocytes is increased.&#10;C)Cells are made larger because fewer of them exist.&#10;D)Cell division is impaired.

Accepted Answer

Red cell production is asynchronous in megaloblastic anemias,with nuclear development lagging behind that of the cytoplasm.Because DNA synthesis is affected,cell division does not occur normally and the cells become larger.

Question 7

Which of the following bone marrow findings would be unexpected in megaloblastic anemia?&#10;A)nuclear cytoplasmic asynchrony&#10;B)giant bands and metas&#10;C)hypercellularity&#10;D)myeloid-to-erythroid (M:E) ratio of 10:1

Accepted Answer

A M:E ratio of 10:1 would imply that 10 times as many myeloid cells exist as do erythroid precursors in the marrow.However,erythroid hyperplasia occurs in the marrow,so the M:E ratio is decreased to about 1:1.The marrow is hypercellular,nuclear cytoplasmic asynchrony occurs in maturation because of the defect in DNA synthesis,and giant bands and metas are characteristic.

Question 8

What is the most effective treatment for PA?&#10;A)oral folate&#10;B)injections of vitamin B12&#10;C)oral vitamin B12&#10;D)alterations in diet

Accepted Answer

PA is a deficiency of vitamin B₁₂ (not folate)because of a lack of IF,which is required for absorption.The vitamin is usually administered by injection through muscle.Because IF deficiency is the actual defect,taking vitamin B₁₂ orally will be of no benefit because it cannot be absorbed.Administering it by injection bypasses the need for absorption.

Question 9

All of the following have increased need for folate except&#10;A)patients on chemotherapy.&#10;B)pregnant women.&#10;C)infants and children.&#10;D)male adults.

Accepted Answer

Men (i.e.,male adults)should have a diet adequate to meet their folate requirements.Patients on chemotherapy often are given drugs that interfere with DNA metabolism,and so they require more folate.Pregnant women have an increased need to support the growing fetus,as do infants and children,especially during growth spurts.

Question 10

Which of the following is true regarding hypersegmented neutrophils?&#10;A)found in so many conditions that they are not significant&#10;B)reported when neutrophils have four or more nuclear segments&#10;C)are an early, consistent, and specific finding in megaloblastic anemia&#10;D)usually accompany microcytic red cells

Accepted Answer

Hypersegmented neutrophils are consistently found early in megaloblastic anemia.Because they are not found in any other condition,they are considered specific.Thus they usually accompany macrocytic red cells (including macroovalocytes).Laboratories may use differing criteria for hypersegmentation.However,all would agree that observation of one six-lobed neutrophil is evidence of hypersegmentation.Some will do a neutrophil lobe count,and report hypersegmentation when the average is greater than 3.4.

Question 11

Megaloblastic anemias are caused by a defect in the synthesis of&#10;A)deoxyribonucleic acid (DNA).&#10;B)ribonucleic acid (RNA).&#10;C)erythropoietin.&#10;D)heme.

Accepted Answer

The answer of Megaloblastic anemias are caused by a defect...

Question 12

A patient with moderate anemia has an elevated MCV and hypersegmented neutrophils.Which of the following should be ordered first?&#10;A)Schilling test&#10;B)gastric analysis&#10;C)antibodies to IF&#10;D)vitamin B12 and folate assays

Accepted Answer

The answer of A patient with moderate anemia has an...

Question 13

Which of the following is decreased in megaloblastic anemia?&#10;A)reticulocyte production index (RPI)&#10;B)MCV&#10;C)lactic dehydrogenase (LD)&#10;D)bilirubin

Accepted Answer

The answer of Which of the following is decreased in...

Question 14

PA can be distinguished from folate deficiency by the&#10;A)presence of hypersegmented neutrophils.&#10;B)mean cell volume (MCV).&#10;C)bone marrow findings.&#10;D)presence of autoantibodies to IF.

Accepted Answer

The answer of PA can be distinguished from folate deficiency...

Question 15

Which of the following tests for PA would be easiest for the patient?&#10;A)vitamin B12 assay&#10;B)bone marrow&#10;C)gastric analysis&#10;D)Schilling test

Accepted Answer

The answer of Which of the following tests for PA...

Question 16

Decreased folate is often associated with all of the following except&#10;A)neural tube defects.&#10;B)increased potassium.&#10;C)microcytic anemia.&#10;D)hyperhomocysteinemia.

Accepted Answer

The answer of Decreased folate is often associated with all...

Question 17

Which vitamins are required for the nuclear development of blood cells?&#10;A)vitamin C and folate&#10;B)vitamin B6 and folate&#10;C)vitamin B12 and folate&#10;D)vitamin B12 and D

Accepted Answer

The answer of Which vitamins are required for the nuclear...

Question 18

Which of the following is the best source of dietary vitamin B&#8321;&#8322;?&#10;A)fruit&#10;B)green vegetables&#10;C)meat&#10;D)legumes

Accepted Answer

The answer of Which of the following is the best...

Question 19

Which of the following is elevated in megaloblastic anemia?&#10;A)white blood count&#10;B)mean cell hemoglobin (MCH)&#10;C)red blood count&#10;D)platelet count

Accepted Answer

The answer of Which of the following is elevated in...

Question 20

A patient has a decreased vitamin B&#8321;&#8322; assay.The Schilling test detects labeled vitamin B&#8321;&#8322; in the urine when it is given with IF.What is the correct interpretation?&#10;A)vitamin B12 assay probably incorrect&#10;B)PA&#10;C)vitamin B12 deficiency that is not PA&#10;D)gastric analysis should be performed

Accepted Answer

The answer of A patient has a decreased vitamin B&#8321;&#8322;...

Question 21

What salivary protein is important for the transport of dietary vitamin B&#8321;&#8322; to the small intestine?&#10;A)trypsin&#10;B)IF&#10;C)haptocorrin&#10;D)transcobalamin II

Accepted Answer

The answer of What salivary protein is important for the...

Deck 21: Anemias Caused by Defects of DNA Metabolism