20. Red Cell Disorders 3

Question 1

A 42 year old homeless man is brought to the doctor cause he was passed out in the middle of the street. He is given fluids and when he awakes he is speaking nonsense and his tongue is beefy red. The man is likely lacking what vitamin.

A. Cobalamin 
B. Riboflavin
C. Folate 
D. Iron 
E. Biotin

RFA

Answer 1

ANS. A Cobalamin( B12)- The patient has the classic symptoms of B12 def. of neurological symptoms and beefy red tongue of B12 def.

B. Riboflavin is B2-think dryness

C. Folate- symptoms similar to B12 but no neuro symptoms

D. Iron- similar to B12 add in Pica

E. Biotin- B7 hair loss

Question 2

A 17 year old in Sierra Leone who eat mostly a diet of rice a day. Comes to the doctor with symptoms of fatigue, palpitations and has been eating clay. What portion of the GI tract absorbs most of the nutrient that the patient is lacking?

A. Jejunum 
B. Parietal Cells 
C. Duodenum 
D. Cecum
E. Colon 

RFA

Answer 2

Ans. C Duodenum- the patient has Iron deficiency anemia as show by the Pica ( eating of clay)

A. Jejunum- Folate

B. Parietal Cells- B12

D & E nothing of note for these chapters are absorbed here.

Question 3

A 65 y/o depressed woman has had a poor appetite over the past few months. She presents with pallor, fatigue, glossitis, MCV>100, elevated homocystine and elevated methylmalonic acid. Which of the following disorders does she have?

A. Iron deficiency anemia 
B. Folate deficiency anemia
C. Vit B12 deficiency anemia
D. Sickle Cell anemia
E. Hereditary Spherocytosis 

SZ

Answer 3

Ans. C. Vit B12 deficiency anemia

Methylmalonic acid is specific to Vit B12 deficiency. It causes damage to myelination of dorsal and lateral tracts which causes sensory and motor loss of lower limbs.

A. Iron deficiency anemia is a microcytic anemia MCV<80

Question 4

A 55 y/o cancer patient presents with increased fatigue, dyspnea, palpitations and ice cravings. She has had difficulty swallowing and glossitis the last few weeks. Which of the following would the patient also have on labs?

A. Increased MCV
B. Decreased folate
C. Increased homocystine
D. Increased TIBC
E. Decreased ferritin

SZ

Answer 4

Ans. D and E Increased TIBC and decreased ferritin

Patient has iron deficiency anemia. She is experiencing Plummer-Vinson syndrome which is caused by mucosa outgrowth called an esophageal web.