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IM1 LE3 Flashcards

1
Q 
You cannot give glucocorticoids to the following patients, except:
A. Leukemia
B. Castleman's disease
C. Lymphoma
D. Infectious mononucleosis
A

D. Can cause pharyngeal obstruction by enlarged lymphoid tissue in the Waldeyer’s ring; can be life-threathening

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2
Q

One can say that lymphadenopathy requires biopsy, when there is/are: (risk factors)

A

> 40 yo, supraclavicular location, size is >2.25cm2, hard texture, nontender/nonpainful

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3
Q

True or False: Most lymphadenopathy requires biopsy.

A

False. Most of them are benign. Most studies shows that CBC is more useful.

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4
Q 
CBC is useful for the diagnosis of the following, except:
A. Acute Leukemia
B. Chronic Leukemia
C. SLE
D. EBV/CMV mononucleosis
A

C. Should be ANA

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5
Q

Thoracic adenopathy can be detected by:

A

Chest radiography or during workup for superficial adenopathy

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6
Q

The following are not function of spleen, except:
A. Synthesis of antigen in the white pulp
B. Synthesis of antibodies in the red pulp
C. Maintenance of quality control of erythrocytes in the white pulp
D. Maintenance of quality control of erythrocytes in the red pulp

A

D. By removal of senescent and defective RBC

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7
Q

True or False: Spleen sequester and store RBC.

A

False. Spleen does not sequester and store RBC. Animals do. In humans, spleen contains 1/3 of total body PLT and marginated neutrophils. These sequestered cells are available to respond to bleeding or infection.

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8
Q

Massive splenomegaly can cause:

A

Satiety

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9
Q

True or False: The rupture of spleen is painful.

A

False. Its rupture is usually painless.

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10
Q

Palpation of the spleen is accomplished by:

A

Middleton maneuver (bimanual palpation, ballotment, palpation from above)

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11
Q 
Percussion of spleen can be done by the following, except:
A. Nixon's
B. Middleton's
C. Castell's
D. Barkun's
A

B. Middleton’s - Palpation

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12
Q

Procedure of choice for routine assessment of spleen

A

Ultrasound

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13
Q 
Erythrocyte count is increased in:
A. Polycythemia vera
B. SLE
C. Thalassemia major
D. Felty's syndrome
A

A. Correct: All blood cells are increased
B. Normal, decreased
C. Normal, decreased
D. Granulocyte: Normal, decreased

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14
Q

When can you say there is a splenomegaly?

A

Spleen:

  1. Extends >8 cm below the left costal margin
  2. Weighs >1000 g
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15
Q

Only contraindication to splenectomy:

A

Marrow failure, in which enlarged spleen is the only source of hematopoietic tissue

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16
Q

2 weeks pre-splenectomy vaccination includes:

A

Pneumococcal conjugate vaccine - more effective
N. meningitidis vaccine - may also be given
HiB vaccine - post-splenectomy

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17
Q

Coexistence of this disease with splenomegaly can cause hemoglobinopathies, such as thalassemia or hemoglobin C:

A

Sickle cell disease

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18
Q 
The following are causes of JAK2 mutation, except:
A. Chronic myelogenous leukemia
B. Polycythemia vera
C. Primary myelofibrosis
D. Essential thrombocytosis
A

A. Balanced translocation between chromosomes 9 and 22; t(9;22)

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19
Q

Most common myeloproliferative disorder:

A

Polycythemia vera: Familial, women predominate in sporadic cases

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20
Q

Etiology of polycythemia vera:

A

Unknown

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21
Q

Most common cytogenetic abnormality in polycythemia vera:

A

JAK2 located in chromosome 9 and loss of heterozygosity on chromosome 9p (due to mitotic recombination) –> Leads to homozygosity

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22
Q 
Initial presenting sign of polycythemia vera:
A. Hepatomegaly
B. Splenomegaly
C. Aquagenic pruritus
D. High hemoglobin or hematocrit
A

B. Correct
A. No association
C. Assoc. with erythrocytosis
D. First recognized but splenomegaly is the true initial

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23
Q 
Erythromelalgia is a symptom complex composed of, except:
A. Myalgia
B. Erythema
C. Burning sensation
D. Pain
A

A.

Notes: Erythromelalgia is a complication of thrombocytosis in polycythemia vera due to platelet stickiness

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24
Q 
Large turnover of hematopoietic cells in polycythemia vera can lead to:
A. Hypokalemia
B. Hyperuricemia
C. Metabolic alkalosis
D. Hypophosphatemia
A

B. Correct. It can also lead to uric acid stones, hypermetabolism.

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25
Q

True about Gaisbock’s Syndrome:
A. Elevated red cell mass with normal plasma volume
B. Elevated red cell mass with high plasma volume
C. Decreased red cell mass with high plasma volume
D. Decreased red cell mass with normal plasma volume

A

B.

Notes: Seen in polycythemia vera; Red cell mass and plasma volume determinations are mandatory to establish the absolute erythrocytosis (to distinguish from relative erythrocytosis due to a reduction in plasma volume)

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26
Q

True or False: Arterial oxygen concentration is normal in polycythemia vera.

A

True

Notes: Hypoxic erythrocytosis has a low arterial O2 conc.

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27
Q 
The following can cause microcytic erythrocytosis, except:
A. a-thalassemia
B. B-thalassemia
C. Hypoxic erythrocytosis
D. Polycythemia vera
A

A. Not associated

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28
Q 
System abnormality that can mask the presence of polycythemia vera:
A. Neurologic
B. GU
C. GI
D. Musculoskeletal
A

C. GI: Peptic ulcer disease, related to bleeding, masks PV

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29
Q

True or False: BM aspiration and biopsy is needed to diagnose polycythemia vera.

A

False. Does not provide diagnostic info since it may be normal or indistinguishable from essential thrombocytosis and primary myelofibrosis

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30
Q 
Causes of relative erythrocytosis, except:
A. Carbon monoxide poisoning
B. Dehydration
C. Tobacco smoking
D. Ethanol abuse
A

A. One of the causes of absolute erythrocytosis. Others include, polycythemia vera, sleep apnea syndrome, etc.

Check Table 108-2 of Chapter 108

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31
Q 
Pruritus in polycythemia vera may be related to:
A. Elevated erythrocytes
B. Elevated platelets
C. Elevated eosinophils
D. Elevated basophils
A

D. Activation by JAK2 V617F

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32
Q 
Most common complication of polycythemia vera (PV):
A. Migraine
B. Thrombosis
C. Pruritus
D. Ulcer
A

A. CNS symptom of PV
B. Correct; Secondary to erythrocytosis; It is important to maintain Hgb and Hct level
C. One of the symptoms due to basophil
D. GI symptoms that may mask PV

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33
Q

True or False: Salicylates can be used to treat thrombosis in polycythemia vera (PV)

A

False. It is harmful and not proven as a remedy

Notes: Anticoagulants are indicated

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34
Q 
Allopurinol can be used to treat/reduce the following, except:
A. Pruritus
B. Splenomegaly
C. Leukocytosis
D. Thrombosis
A

D. Anticoagulants
A, B, C. Indicated but not always

Notes: Asymptomatic hyperuricemia in PV usually requires no therapy, but Allopurinol can be given to avoid further elevation

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35
Q

True or False: Splenomegaly requires no treatment even if symptomatic.

A

False. Splenomegaly can be treated with IFN-a, but can show side effects if used chronically.

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36
Q 
Primary myelofibrosis is characterized by, except:
A. Marrow fibrosis
B. Medullary hematopoiesis
C. Extramedullary hematopoiesis
D. Splenomegaly
A

B.

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37
Q 
Least common myeloproliferative disease:
A. Polycythemia vera
B. Primary myelofibrosis
C. Essential thrombocytosis
D. Chronic eosinophilic leukemia
A

B.

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38
Q 
JP, a 63-year old male, smoker, drinks alcohol twice a day 5 days a week, and seems to be hypertensive upon PE. He was diagnosed to have agnogenic myeloid metaplasia. Which of the following predisposes him to this condition?
A. Smoking
B. Alcohol
C. Hypertension
D. Gender and age
A

D. Agnogenic myeloid metaplasia can occur at any age, but primarily afflicts men in their sixth decade or later.

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39
Q

Overproduction causes marrow angiogenesis in primary myelofibrosis?
A. Vascular endothelial growth factor
B. Osteoprotegerin
C. Transforming growth factor B
D. Tissue inhibitors of metalloproteinases

A

A. Correct

B. Overproduction associated with osteosclerosis; an osteoclast inhibitor
C and D. Overproduction associated with fibrosis

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40
Q 
A 30 years old male came to your clinic with symptoms of weight loss, fatigue and night sweats. Upon examination, you figured out that he has splenomegaly. You knew that this presentations are unique to what myeloproliferative disorder?
A. Chronic neutrophilic leukemia
B. Polycythemia vera
C. Tuberculosis
D. Myelofibrosis with myeloid metaplasia
A

D. Also known as Primary Myelofibrosis

Notes: In contrast to its companion myeloproliferative disorders (MPDs), night sweats, fatigue and weight loss is common in PMF.

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41
Q

Teardrop-shaped red blood cells are seen in:

A

Primary myelofibrosis (PMF)

Notes: Addition to that, you can also see nucleated red cells, myelocytes, promyelocytes and myoblasts in PMF’s peripheral blood smear, indicative of extramedullary hematopoiesis.

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42
Q

What fibrosis of the bone marrow is secondary to a tumor/granulomatous process?

A

Myelophthisis

Notes: Myelofibrosis - fibrosis due to primary hematologic process

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43
Q

True or False: Primary myelofibrosis is associated with anemia.

A

True.

Notes: Anemia, usually mild initially.

Additional notes: Leukocytes and platelets are normal or increased, but may be depressed

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44
Q 
Enzymes elevated in primary myelofibrosis:
A. Lactate dehydrogenase
B. Alkaline phosphatase
C. Both
D. Neither
A

C. Both

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45
Q

True or False: Primary myelofibrosis can be diagnosed by bone marrow aspiration.

A

False.

Notes: Marrow is not usually aspirable due to increased marrow reticulin (fibrosis), but MARROW BIOPSY will reveal hypercellular marrow with increased number of megakaryocytes in clusters and with large nuclei.

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46
Q

True or False: Primary myelofibrosis is associated with autoimmune abnormalities.

A

True.

Notes: Associated with immune complexes, ANA, rheumatoid factor, positive in Coombs’ test

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47
Q

This cluster of differentiation is increased in PMF, unlike any other MPDs:

A

CD 34+ cells

Notes: >15,000/uL - associated to myeloid metaplasia

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48
Q 
Mutation with what gene is associated with anemia:
A. JAK2
B. MPL
C. GGCC
D. JAK3
A

B.

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49
Q 
What hematologic abnormality can exacerbate primary myelofibrosis?
A. IDA
B. Pernicious Anemia
C. Folic acid deficiency
D. Nonmegaloblastic anemia
A

C.

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50
Q

Therapy for primary myelofibrosis (PMF):

A

No specific therapy, but pyridoxine therapy has been effective in rare instances.

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51
Q 
Anemia in PMF may be due to:
A. GI blood loss
B. Ineffective erythropoiesis
C. Neither
D. Both
A

D.

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52
Q 
Proved useful in controlling organomegaly in PMF:
A. Allopurinol
B. Hydroxyurea
C. Danazol
D. Glucocorticoids
A

B.

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53
Q 
The following can alleviate splenomegaly, except:
A. JAK2 inhibitors
B. Hydroxyurea
C. Glucocorticoids
D. Danazol
A

D. An androgen analog

54
Q 
Essential thrombocytosis (ET) is characterized by, except:
A. Unknown etiology
B. Female predominance
C. Occur at any age
D. Male predominance
A

D. Only in PMF

55
Q 
Reduplication of megakaryocytes is characterized as:
A. Exomitotic
B. Endomitotic
C. Exomiosis
D. Endomiosis
A

B.

Notes: In the absence of thrombopoietin, reduplication via endomitotis and cytoplasmic development is impaired.

56
Q

True or False: Platelet count is directly proportional to plasma thrombopoietic activity.

A

False.

Notes: They have inverse correlation

57
Q

Essential thrombocytosis is:
A. Autosomal dominant
B. Autosomal recessive

A

A.

58
Q 
ET is most often identified with this routine medical evaluation (not for diagnosis):
A. Biopsy
B. Aspiration
C. CBC
D. Gene analysis
A

C.

Notes: Specifically, the platelet count

59
Q 
Massive splenomegaly can be seen in all of the following, except:
A. PV
B. ET
C. PMF
D. CML
A

ET

Notes: Only MPD with mild splenomegaly

60
Q 
Massive circulating platelet may prevent the measurement of which electrolyte?
A. Sodium
B. Chloride
C. Phosphate
D. Potassium
A

D.

Notes: This is due to release of platelet potassium upon blood clotting.

61
Q 
This abnormality may be present in essential thrombocytosis (ET):
A. Anemia
B. Abnormal PT and PTT
C. Prolonged bleeding time
D. All of the above
A

C.

Notes: This comes with impaired platelet aggregation

62
Q

Preferred assay in patients with thrombocytosis to whom is negative in Ph chromosome:

A

FISH analysis for bcl-abl

63
Q

True or False: ET can evolve to PV or PMF.

A

True.

64
Q 
The following can be used to reduce platelet count, except:
A. Interferon-a
B. Anagleride
C. Hydroxyurea
D. Aspirin
A

D. Could promote hemorrhage

65
Q 
Event when iron supplementation is required, except:
A. Not increase erythropoiesis
B. Pregnancy delivery
C. Ionizable iron salts taken with food
D. Vegetarianism
A

A.

Notes:
B. Blood loss
C. Reduced absorption
D. Dark green veggies decreases absorption of iron. Coffee, tea, calcium, whole wheat flour, lentils, etc, can also decrease iron absorption

66
Q

True about iron transport, except:
A. When erythropoiesis is increased, the pool of erythroid cells requiring iron increases and clearance time of iron from circulation decreases
B. When erythropoiesis is suppresed, plasma iron increases and half-clearance time may be shortened
C. When erythropoiesis is suppresed, plasma iron increases and half-clearance time may be prolonged
D. Half-clearance of iron in presence of iron deficiency is shortened

A

B.

Notes:
EPO activation = iron usage (ex: Activated EPO increases erythroid cells that requires iron [iron will decrease in plasma, that’s why half-time clearance is shortened])

EPO suppression = increase plasma iron (prolonged half-clerance)

Normal half-time clearance = 60-90 mins

67
Q 
Highest affinity for transferrin receptors:
A. Apotransferrin
B. Monoferric transferrin
C. Diferric transferrin
D. Triferric transferrin
A

C.

A. Very little affinity
B. Little affinity
D. There’s no such thing. Lol.

68
Q 
Storage protein of iron:
A. Apoferritin
B. Apotransferrin
C. Transferrin
D. Myoglobin
A

A. Eventually forms ferritin

69
Q 
Life span of RBC (super recall):
A. 115 days
B. 115 hours
C. 120 days
D. 120 hours
A

C. 0.8-1% of RBC turnover each day

70
Q 
Mechanisms by which iron is lost from the body, except:
A. Caesarean section
B. Menstruation
C. Necrosis of skin
D. Hepatitis
A

D. Inflammation interferes with iron release from stores that leads to decrease in serum iron (but not actually lost)

Notes: The only mechanism by which iron is lost is blood loss. Also loss of epithelial cells from skin, GI and GU tract

71
Q 
Most readily absorbed iron from food:
A. Red meat
B. Veggies
C. Eggs
D. Liver
A

A. About half to 2/3 - correct

B. 1/12
C. 1/8
D. 1/2 - next, if heme iron (red meat) was not stated

72
Q

True or False: Iron absorption takes place largely in the ileum.

A

False. Ileum is the distal part of small intestine

Notes: Iron absorption takes place largely in the proximal part of small instestine (probably in duodenum and jejunum)

73
Q 
Principal iron regulatory hormone:
A. Ferroportin
B. Hepcidin
C. Hephaestin
D. Transferrin
A

B. Negatively regulate ferroportin

A. Membrane-embedded iron EXPORTER
C. Copper-carrying protein (like ceruloplasmin), oxidizes iron to ferric form for transferrin binding
D. For transport

74
Q

Erythroid hyperplasia:
A. High iron absorption, low hepcidin levels
B. Normal iron absorption, high hepcidin levels
C. Low iron absorption, low hepcidin levels
D. High iron absorptio, high hepcidin levels

A

A.

75
Q 
You can see the following in 'negative iron balance' stage of IDA, except:
A. Decrease iron stores
B. Decrease serum ferritin
C. Increase total iron-binding capacity
D. Increase RBC protoporphyrin
A

D. Can be seen in ‘iron-deficient erythropoiesis’

A. Reflected by ferritin or stainable iron on BMA
B. Related to A
C. Can be normal if iron stores are present, but can be seen in this particular stage as increased
D. Can be normal if iron stores are sufficient, which is in this case was not.

Notes: Red cell morphology and indices in this stage are all normal

76
Q

True or False: In severe prolonged IDA, hypoproliferation occurs.

A

False. Erythroid hyperplasi of the marrow develops, which stimulates iron absorption and decreased levels of hepcidin.

77
Q 
Instances that one have increased demand for iron, except:
A. Infancy
B. Erythropoietin therapy
C. Pregnancy
D. Crohn's disease
A

D. Crohn’s is assoc. with malabsorption, not increased in demand

78
Q 
Sign of advance tissue iron deficiency:
A. Pallor
B. Cheilosis
C. Reduced exercise capacity
D. Fatigue
A

B. Along with koilonychia

A, C and D - usual signs of anemia

79
Q 
Normal range of serum iron:
A. 50-100 ug/dL
B. 50-150 ug/dL
C. 40-140 ug/dL
D. 40-100 ud/dL
A

B.

Notes: Total iron-binding capacity (TIBC) normal range is 300-360 ug/dL. This is the indirect measure of circulating transferrin with iron bounded to it.

80
Q

True or False: Hemosiderin is more readily available than ferritin.

A

False.

Notes: Within cells, iron is stored complexed to protein as ferritin or hemosiderin. As ferritin accumulates within cells of RE system, protein aggregates formed as hemosiderin.

81
Q 
Most convenient lab test to estimate iron stores:
A. Transferrin
B. Apoferritin
C. Ferritin
D. Hemosiderin
A

C.

82
Q

True or False: Bone marrow aspiration and biopsy are used to detect iron overload.

A

False. Before, it can be used. But serum ferritin level largely supplanted them.

Only advantage of marrow iron stain is that it provides info about effective delivery of iron to developing erythroblasts.

83
Q 
Cigar-shaped forms of RBC can be seen in, except:
A. Hypochromia
B. Normocytosis
C. Microcytosis
D. None is an exception
A

B.

Notes: Cigar-shaped or pencil-shaped forms of RBC can be seen in IDA, which is hypochromic and microcytic.

84
Q

True or False: Absence of ferritin granules in sideroblasts’ cytoplasm indicates iron overload.

A

False. Ferritin granules should be present in sideroblasts’ cytoplasm to say that there is iron overload.

85
Q

Ringed sideroblasts are referred to as:
A. Accumulation of iron in cytoplasm of erythroblast
B. Accumulation of iron in the nucleus of erythroblast
C. Accumulation of iron in the mitochondria of erythroblast
D. Accumulation of iron in plasma membrane of erythroblast

A

C.

Notes: In myelodysplastic syndromes, mitochondrial dysfunction can occur, and accumulation of iron in mitochondria appears in a necklase fashion around the nucleus of erythroblast. Such cells are called ringed sideroblasts.

86
Q 
Increased red cell protoporphyrin levels are associated with:
A. Increased absoluted iron
B. Normal relative iron
C. Increased heme synthesis
D. Lead poisoning
A

D.

Notes: Also assoc. with absolute and relative iron deficiency.

87
Q 
What reflects the total erythroid marrow mass?
A. TRP
B. Ferritin
C. Transferrin
D. TIBC
A

A. Transferrin receptor protein

Notes: Recall that it is released in the circulation after iron transfer. It is elevated in absolute iron deficiency. Can be used to distinguish IDA from anemia of chronic inflammation, along with serum ferritin levels (most widely used in differentiation between IDA and anemia of inflammation).

88
Q

What makes IDA different from thalassemias?

A

Iron levels in thalassemias and also in myelodysplastic syndrome are normal or increased. Also, RBW index in thalassemias/MDS is small, while elevated in IDA.

Similarities: Both hypochromic and microcytic.

89
Q

What should you watch out for the most in oral iron therapy?

A

GI distress

90
Q 
Hypoproliferative anemias can be divided into these four groups, except:
A. Acute inflammation
B. Chronic inflammation
C. Renal disease
D. Hypometabolic states
A

A. Marrow damage, instead. Also, anemia in acute inflammation is usually mild, but may become more pronounced over time.

91
Q

True or False: In marrow damage, you will find inadequate endogenous EPO production.

A

False. Appropriate elevation in endogenous EPO levels are typically found.

Notes: Depressed endogenous EPO production can be found in chronic inflammation, renal and hypometabolic anemia.

92
Q 
You would characterized the anemia of a patient with cancer as, except:
A. Increased red cell protoporphyrin
B. Transferrin saturation of 15-20%
C. Decreased serum ferritin levels
D. Low serum iron
A

C.

Notes: Anemia in cancer is under the anemia of inflammation, which is characterized by low serum iron, increased red cell protoporphyrin, hypoproliferative marrow, transferrin saturation of 15-20% (low), and NORMAL to INCREASED serum ferritin levels.

93
Q

How can you explain the normal to increased serum ferritin levels in anemia of inflammation?

A

Due to effects of inflammatory cytokines (IL-1, IFN-y, TNF) and hepcidin.

94
Q

True or False: Serum ferritin levels is necessary to rule out absolute iron deficiency in chronic inflammation-associated anemia.

A

False. This time, marrow aspirate stained for iron may be necessary.

95
Q 
Patients with anemia of CKD presents with the following, except:
A. Normal serum iron
B. Normal TIBC
C. Normal ferritin levels
D. Normal reticulocyte count
A

D. Reticulocytes are decreased.

Notes: Anemia of CKD usually associated with moderate to severe hypoproliferative anemia. Red cells are normocytic, normochromic, and reticulocytes are decreased. Also, they are usually presented with normal serum iron, TIBC and ferritin levels. However, those who are maintained in chronic dialysis may develop iron deficiency.

96
Q

True or False: Starvation can cause anemia.

A

True. As well as hypothyroidism.

97
Q

True or False: Administration of estrogen in men increases erythropoiesis.

A

False.

Notes: Testosterone and anabolic steroids augment EPO while castration and estrogen administration in men decreases it.

98
Q

True about anemia in liver disease, except:
A. Peripheral blood smear may show spur cells and stomacytes
B. Red cell survival is prolonged
C. EPO production is inadequate
D. Mild hypoproliferative anemia

A

B. Shortened.

99
Q

True or False: Reversal of anemia in end-stage renal disease is not possible.

A

True. Along with chronic inflammatory diseases. Symptomatic anemia requires treatment (transfusions, EPO), but watch out for overload.

100
Q 
The following can interrupt EPO therapy, except:
A. Hypothyroidism
B. Hyperparathyroidism
C. Aluminum toxicity
D. Infection
A

A. Hypothyroidism

101
Q 
Form of cobalamin in human plasma and cell cytoplasm:
A. Adocobalamin
B. Hydroxycobalamin
C. Methylcobalamin
D. Transcobalamin
A

C. Correct

A. Vitamin itself
B. From ado- and methylcobalamin
D. Glycoprotein produced by salivary glands of the mouth

102
Q

True or False: Human body cannot degrade cobalamin.

A

True.

103
Q

Absorption of cobalamin is mediated by:

A

Intrinsic factor

104
Q

Cobalamin-binding proteins

A

Haptocorrins (HCs) or Transcobalamin I (TC I)

105
Q 
Transcobalamin responsible for cobalamin transport to tissues:
A. TC I
B. TC II
C. Haptocorrins
D. A and C
A

B.

A, C, D: All the same

106
Q 
Dietary folates are converted to this form before entering portal plasma:
A. Polyglutamate
B. Diglutamate
C. THF
D. 5-MTHF
A

D. 5-methylTHF, usually in monoglutamate form

Notes: Polyglutamates are hydrolyzed to monoglutamates in the form of 5-MTHF, because polyglutamates are less efficient in absorption.

107
Q

Folate transported to plasma in relation to albumin:

A

1/3 is loosely bound to albumin, 2/3 is unbound

108
Q

2 types of folate-binding proteins involved in entry of MTHF into cells:

A
  1. High-affinity proton-coupled folate receptor

2. Low-affinity reduced-folate carrier (this also regulates uptake of methotrexate)

109
Q

True or False: Folate and Cobalamin is a cofactor for methionine synthesis.

A

True. Specifically MTHF and methylcobalamin

110
Q

MOA of Methotrexate:

A

Inhibits DHF reductase, prevents formation of active THF coenzymes

111
Q

Common features of all megaloblastic anemias:

A

Defects in DNA synthesis

that affects rapidly dividing cells in the bone marrow

112
Q

Deficiency of either folate or cobalamin can lead to which main problem of megaloblastic anemia?

A

Failure to convert dUMP to dTMP

113
Q

THF starvation can be seen in:
A. Folate deficiency
B. Cobalamin deficiency
C. Both

A

C. Can be seen in cobalamin deficiency, but eventually lead to folate deficiency

Notes: MTHF accumulates in plasma, intracellular folate levels fall due to failure of formation of THF

114
Q

A patient came to your clinic with glossitis, mild fever, jaundice and skin hyperpigmentation. What is the diagnosis?

A

Megaloblastic anemia (folate or cobalamin deficiency)

115
Q

True or False: Cobalamin deficiency is associated with impaired bactericidal function of phagocytes.

A

True.

116
Q

Associated with neural tube defects:
A. Folate deficiency only
B. Cobalamin deficiency
C. Folate, Cobalamin deficiency

A

C.

117
Q

True or False: Antiepileptic drug can cause neural tube defect.

A

True.

118
Q

Cobalamin deficiency is usually due to:

A

Malabsorption, or inadequate dietary intake

119
Q

What antibodies are present in adult pernicious anemia that is absent in juvenile pernicious anemia?

A

Parietal cell antibodies

120
Q

Most common cause of megaloblastic anemia due to cobalamin deficiency:

A

Imerslund syndrome

Notes: Normal IF and gastric acid secretion but unable to absorb cobalamin. Normal renal function and renal biopsy, but there’s nonspecific proteinuria.

121
Q

True or false: Gluten-free diet can cause cobalamin deficiency.

A

False. Gluten can induce enteropathy that can cause cobalamin deficiency.

122
Q

True or False: Sodium is associated with cobalamin absorption.

A

False. It is usually calcium that maintains normal cobalamin absorption.

123
Q

True or False: Adocobalamin is inactivated by nitrous oxide.

A

False.

124
Q

Folate requirement in pregnancy is increased, mainly because of:
A. Transfer of vitamins to fetus
B. Increase folate catabolism
C. Both

A

B.

Notes: Partly because of transfer of vitamins to fetus, but mainly due to catabolism of folate due to cleavage of folate coenzymes in rapidly proliferating tissues.

125
Q 
All of the following are folate antagonists, except:
A. Spirit-drinking
B. Anticonvulsants
C. Beer
D. Methotrexate
A

C. Beer is relatively folate-rich in some countries, depending on technique used for brewing.

126
Q 
Serum cobalamin is measured by:
A. ELISA
B. CBC
C. Urinalysis
D. None of the above.
A

A. Also serum folate can be measured by ELISA

127
Q

Antidote of methotraxate:

A

Folinic acid (5-formyl-THF)

128
Q 
Folic acid requirement during pregnancy:
A. 400 mg
B. 400 ug
C. 400 g
D. 400 mL
A

B.

Notes: If women have had previous fetus with NTD, 5 mg of folate daily is recommended when pregnancy is contemplated

129
Q 
WHO recommended routine supplementation in children:
A. Cobalamin and iron
B. Cobalamin and folate
C. Iron and folate
D. Iron only
A

C.

130
Q

True or False: Antiviral nucleoside can cause megaloblastic anemia.

A

True. But not cobalamin or folate deficiency

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