Question 1

The MCV in pernicious anemia will be in the range of:&#10;A) 70 to 80 fL&#10;B) 85 to 95 fL&#10;C) 110 to 120 fL&#10;D) 90 to 98 fL

Accepted Answer

Pernicious anemia is a type of megaloblastic anemia, which is characterized by macrocytic red blood cells. The MCV (mean corpuscular volume) in pernicious anemia is typically greater than 100 fL, with a range of 110 to 120 fL. Option A is incorrect because 70-80 fL is considered to be microcytic, not macrocytic. Option B is incorrect because 85 to 95 fL is within the normal range for MCV. Option D is also incorrect as it does not fall within the expected range for MCV in pernicious anemia.

Question 2

A bone marrow aspiration/examination is not necessary for patients with megaloblastic anemia.

Accepted Answer

Megaloblastic anemia is caused by deficiencies in vitamin B12 or folate, which results in abnormal red blood cell production. A bone marrow aspiration/examination is not necessary for diagnosis and management of megaloblastic anemia, as it can be diagnosed by simple blood tests and treated with vitamin supplementation. However, if other causes of anemia need to be ruled out, a bone marrow aspiration/examination may be required.

Question 3

One of the most common pathophysiologies that contribute to folic acid deficiency is:&#10;A) Tropical sprue&#10;B) Intrinsic factor deficiency&#10;C) IDA&#10;D) Infection with Diphyllobothrium latum

Accepted Answer

Tropical sprue is a condition that affects the small intestine and impairs absorption of nutrients, including folic acid. This leads to folic acid deficiency. Intrinsic factor deficiency (choice B) primarily leads to vitamin B12 deficiency, not folic acid deficiency. IDA (choice C) can cause anemia but does not directly affect folic acid levels. Infection with Diphyllobothrium latum (choice D) can cause vitamin B12 deficiency but does not directly affect folic acid levels.

Question 4

All of the following are true about intrinsic factor (IF) except:&#10;A) Partial gastrectomy may lead to the lack of IF.&#10;B) 56% of patients with pernicious anemia have antibodies to IF.&#10;C) Atrophic gastritis may lead to the lack of IF.&#10;D) Kidney failure may lead to lack of IF.

Accepted Answer

Kidney failure does not lead to lack of IF. IF is produced by parietal cells in the stomach, and kidney function does not directly impact its production or function. The other options are true, as partial gastrectomy, pernicious anemia, and atrophic gastritis can all lead to a lack of IF.

Question 5

Evidence of ineffective erythropoiesis in the CBC of patients with megaloblastic anemia are:&#10;A) Anemia, thrombocytopenia, leukopenia&#10;B) Anemia, thrombocytosis, leukopenia&#10;C) Anemia, thrombophilia, leukocytosis&#10;D) Anemia, thrombocytosis, leukopenia

Accepted Answer

In megaloblastic anemia, ineffective erythropoiesis often leads to a triad of anemia, thrombocytopenia, and leukopenia due to the impaired DNA synthesis affecting all bone marrow cell lines.

Question 6

Which of the following morphological features is classic in the megaloblastic anemias?&#10;A) Polychromasia&#10;B) Macroovalocytes&#10;C) Basophilic stippling&#10;D) Hypochromia

Accepted Answer

Megaloblastic anemias are characterized by the presence of large red blood cells, known as macroovalocytes, due to impaired DNA synthesis. Polychromasia and basophilic stippling may be seen in various anemias but are not specific to megaloblastic anemias. Hypochromia refers to decreased hemoglobin concentration in red blood cells and is not a feature of megaloblastic anemia.

Question 7

A macrocytosis that is not megaloblastic in origin can be seen in all of the following except:&#10;A) Chemotherapy&#10;B) Postsplenectomy&#10;C) Hypoglycemic patients&#10;D) Reticulocytosis

Accepted Answer

Macrocytosis is commonly associated with megaloblastic anemia, which is caused by impaired DNA synthesis due to vitamin B12 or folate deficiency. However, macrocytosis can also be observed in other conditions such as certain medications (chemotherapy), postsplenectomy, and reticulocytosis. Hypoglycemic patients do not typically exhibit macrocytosis.

Question 8

The Schilling test continues to be an historic reference method for the determination of:&#10;A) IDA&#10;B) Pernicious anemia&#10;C) Folic acid deficiency&#10;D) Hereditary hemochromatosis

Accepted Answer

The Schilling test was developed to diagnose pernicious anemia, an autoimmune disorder that affects the absorption of vitamin B12. The test measures the uptake of radiolabeled vitamin B12 and can determine if the patient has an intrinsic factor deficiency, which is a common cause of pernicious anemia. The Schilling test is not used for the diagnosis of IDA, folic acid deficiency, or hereditary hemochromatosis.

Question 9

A key substance required for the incorporation of vitamin B₁₂ in red cell nuclear synthesis is the presence of: A) EPO B) Transferrin C) Intrinsic factor D) Cytokines

Accepted Answer

Intrinsic factor is required for the absorption of vitamin B12, which is necessary for red cell nuclear synthesis.

Question 10

Macrocytic red blood cells are routinely seen in all the following except:&#10;A) Pernicious anemia&#10;B) Liver disease&#10;C) Response to anemic stress&#10;D) Thalassemia

Accepted Answer

Macrocytic red blood cells are not seen in thalassemia, which is characterized by microcytic red blood cells. Pernicious anemia, liver disease, and response to anemic stress can all cause macrocytic red blood cells.

Question 11

&#10;The cell pictured above may be seen in which of the following conditions?&#10;A) Iron deficiency anemia&#10;B) Megaloblastic anemia&#10;C) Thalassemia major&#10;D) Hereditary hemochromatosis

Accepted Answer

The answer of  &#10;The cell pictured above may be...

Question 12

Intrinsic factor is secreted by the:&#10;A) Parietal cells of the stomach&#10;B) Ileum&#10;C) Thyroid&#10;D) Bone marrow

Accepted Answer

The answer of Intrinsic factor is secreted by the:&#10;A) Parietal...

Question 13

An appropriate M:E ratio in the case of megaloblastic anemia would be:&#10;A) 1:3&#10;B) 4:1&#10;C) 5:1&#10;D) 1:10

Accepted Answer

The answer of An appropriate M:E ratio in the case...

Question 14

A differentiation of treated versus untreated megaloblastic anemia can be determined by the presence of:&#10;A) Polychromasia&#10;B) Hypochromia&#10;C) Howell-Jolly bodies&#10;D) Siderocytes

Accepted Answer

The answer of A differentiation of treated versus untreated megaloblastic...

Question 15

Ineffective erythropoiesis is defined as:&#10;A) An increase in the M:E ratio&#10;B) A synthetic defect in hemoglobin&#10;C) Premature destruction of red cell precursors&#10;D) A DNA maturation defect

Accepted Answer

The answer of Ineffective erythropoiesis is defined as:&#10;A) An increase...

Question 16

&#10;The stage of development of the cell at the end of the pointer is:&#10;A) Polychromatophilic normoblast&#10;B) A reticulocyte&#10;C) A rubricyte&#10;D) An orthochromatic normoblast

Accepted Answer

The answer of  &#10;The stage of development of the...

Question 17

Which of the following terms describes the appearance of the erythropoietic precursors in the megaloblastic process?&#10;A) Ordered arrangement of chromatin&#10;B) Asynchrony&#10;C) Eccentric nucleus&#10;D) Pale cytoplasm

Accepted Answer

The answer of Which of the following terms describes the...

Deck 6: The Macrocytic Anemias