Chapter 41 - Nutritional deficiency

Question 1

Most consistent sign of cobalamin deficiency
A. Unsteady gait
B. Loss of vibration sense
C. Mild symmetrical weakness in proximal limb muscles
D. Extensor plantar responses

Answer 1

B. Loss of vibration sense (p. 1173)

Question 2

Earliest histologic event seen in subacute combined degeneration?
A. Formation of intramyelinic vacuoles and separation of myelin lamellae
B. Coalescence of small foci of tissue destruction
C. Fibrous gliosis
D. Presence of inflammatory infiltrates in the posterior columns

Answer 2

A. Formation of intramyelinic vacuoles and separation of myelin lamellae (p. 1174)

Question 3

Most accurate measurement of serum cobalamin is done by
A. Microbiologic assay using Euglena gracilis
B. Radioisotope dilution assay
C. Determination of cobalamin metabolites methylmalonic acid and homocysteine
D. 2-stage Schilling test
E. Antibodies to intrinsic factor

Answer 3

A. Microbiologic assay using Euglena gracilis (p. 1175)

Question 4

Most important factor factor influencing the response to treatment in vitamin B12 deficiency
A. Duration of symptoms
B. Age
C. Sex
D. Degree of anemia

Answer 4

A. Duration of symptoms (p. 1176)