Megaloblastic and Nonmegaloblastic Anemia MC QUESTIONS

4. All of the following are causes of folate deficiency-induced megaloblastic anemia, EXCEPT: A. pernicious anemia B. decreased intake of folate C. pregnancy D. intestinal blind-loop syndrome

pernicious anemia

6. Which of the following anemias is associated with accompanying psychotic and neural abnormalities of the patient? (Hint: Objective 4) A. pernicious anemia B. folate deficiency C. hypothyroidism D. liver disease

6. pernicious anemia

19. A patient with megaloblastic anemia is treated with folate. A week later her reticulocyte count is 5.0%. This reticulocyte result is most likely due to: (Hint: Objectives 2 and 4) A. liver disease B. pyropoikilocytosis C. response to therapy D. increased hemolysis

19. response to therapy

2. Pernicious anemia is a megaloblastic anemia resulting from: A. dietary deficiency of cobalamin B. folate deficiency C. a deficiency in the amount or function of intrinsic factor D. hepatic cirrhosis

2. a deficiency in the amount or function of intrinsic factor

2. Which of the following test results supports a diagnosis of folic acid deficiency? (Hint: Objectives 2, 7, and 8) A. abnormal Part I Schilling test B. increased serum homocysteine levels C. increased RBC folate and decreased serum folate D. increased urine MMA

2. increased serum homocysteine levels

1. A deficiency in cobalamin or folic acid results in ineffective erythropoiesis because: A. both cobalamin and folic acid are necessary cofactors in the anabolic pathway that synthesizes DNA thymidine B. B12 is necessary to bind folic acid for transport to the erythroid marrow C. both B12 and folic acid are necessary for the uptake of iron into erythroid cells D. folic acid and B12 are vital for the proper synthesis of erythropoietin by the kidneys

1. both cobalamin and folic acid are necessary cofactors in the anabolic pathway that synthesizes DNA thymidine

1. A "typical" blood picture in a patient with megaloblastic anemia includes all of the following characteristics EXCEPT: (Hint: Objectives 3 and 7) A. neutrophil hypersegmentation B. increased serum iron C. ovalocytes on the blood smear D. decreased serum bilirubin

1. decreased serum bilirubin

10. Which test will help differentiate between folic acid deficiency and cobalamin deficiency? (Hint: Objective 4) A. RBC folate B. homocysteine C. serum folate D. MMA

10. MMA

10. If an individual went on a starvation diet, which of the following would develop the earliest? A. a deficiency in folate B. a deficiency in B12 C. a deficiency in iron D. a deficiency in B6

10. a deficiency in folate

11. In the United States, folate deficiency is most commonly due to: A. liver disease B. autoantibodies against IF C. diet D. intestinal blind-loop syndrome

11. diet

11. Which of the following types of cobalamin deficiency due to a failure of intrinsic factor is acquired? (Hint: Objectives 4) A. autoantibodies to parietal cells B. bowel resection C. autoantibodies to the IF-B12 complex D. gastrectomy

11. gastrectomy

12. A 52-year-old homeless male was checked into the hospital suffering from fatigue and alcoholism. His CBC revealed that he was anemic and the erythrocytes were macrocytic. A serum folate and Schilling test were normal. What is the most likely cause of this anemia? (Hint: Objectives 4 and 11) A. pernicious anemia B. hemolytic anemia with shift reticulocytosis C. folic acid deficiency due to malabsorption D. dietary B12 deficiency

12. dietary cobalamin (B12) deficiency

12. Which of the following is a macrocytic, normochromic anemia associated with autoantibodies? A. pernicious anemia B. acute intermittent porphyria C. microangiopathic hemolytic anemia D. anemia of liver disease

12. pernicious anemia

13. Normal serum cobalamin values are approximately: A. 20-200ng/L B. 100-600 ng/L C. 150-450 ng/L D. 1500-2000 ng/L

13. 150-450 pg/mL

13. Which clinical symptom is unique to the cobalamin deficiency found in pernicious anemia and is often used to distinguish it from folate deficiency? (Hint: Objective 4) A. neurologic manifestations B. slight jaundice C. pallor, weakness, light-headedness, and shortness of breath D. epithelial abnormalities

13. neurologic manifestations

14. In a case of megaloblastic anemia, increased intramedullary destruction of RBC precursors leads to: (Hint: Objectives 1 and 3) A. reticulocytosis B. hemorrhage C. iron-deficiency anemia D. chronic hemolysis

14. chronic hemolysis

14. Which of the following is NOT a typical RBC morphological finding for a person with megaloblastic anemia? A. target cells B. Howell-Jolly bodies C. NRBCs D. MCV of 110 fL

14. target cells

15. Which of the following has no effect on cobalamin absorption from the small intestine into the circulation? A. gastrointestinal pH B. transcobalamin C. amount of dietary folate D. intrinsic factor

15. amount of dietary folate

15. A deficiency in cobalamin or folic acid results in ineffective erythropoiesis because: (Hint: Objective 4) A. both cobalamin and folic acid are necessary cofactors in the anabolic pathway that synthesizes DNA thymidine B. cobalamin is necessary to bind folic acid for transport to the erythroid marrow. C. folic acid and cobalamin are vital for the proper synthesis of erythropoietin by the kidneys D. both cobalamin and folic acid are necessary for the uptake of iron into erythroid cells

15. both cobalamin and folic acid are necessary cofactors in the anabolic pathway that synthesizes DNA thymidine

16. A "typical" blood picture of a patient with megaloblastic anemia would include all of the following characteristics EXCEPT: (Hint: Objectives 2 and 4) A. neutrophil hypersegmentation B. hypersegmented PMNs on the blood smear C. decreased serum bilirubin D. increased serum iron

16. decreased serum bilirubin

16. Anemia associated with pregnancy is usually related to iron deficiency; it also may occur in conjunction with a deficiency of: A. erythropoietin B. cobalamin C. folic acid D. vitamin K

16. folic acid

17. Cobalamin plays an important role in relationship to DNA synthesis by the: (Hint: Objectives 1 and 5) A. conversion of vitamin B6 to 5-methyl-tetra-hydrofolate (THF) B. conversion of guanine to thymidine C. conversion of 5-methyl-THF to THF by the conversion of homocystine to methionine D. conversion of deoxyuridine to thymidine

17. conversion of 5-methyl-THF to THF by the conversion of homocystine to methionine

17. The common, basic defect in megaloblastic anemias is: (Hint: Objective 1) A. folate deficiency B. impaired DNA thymidine synthesis C. B12 deficiency D. iron excess

17. impaired DNA thymidine synthesis

18. Which of the following types of cobalamin deficiency is due to a secondary condition that leads to a deficiency of intrinsic factor? A. autoantibodies to parietal cells B. gastrectomy C. autoantibodies to the IF-cobalamin complex D. bowel resection

18. gastrectomy

18. All of the following are causes of folate deficiency-induced megaloblastic anemia EXCEPT: (Hint: Objectives 4 and 6) A. dietary insufficiency B. intestinal blind-loop syndrome C. pernicious anemia D. pregnancy

18. pernicious anemia

19. All of the following are causes of folate deficiency-induced megaloblastic anemia EXCEPT: A. pernicious anemia B. dietary insufficiency C. pregnancy D. intestinal blind-loop syndrome

19. pernicious anemia

20. Cobalamin plays an important role in relationship to DNA synthesis by the: A. conversion of deoxyuridine to thymidine B. conversion of vitamin B6 to 5-methyl-tetrahydrofolate (THF) C. conversion of guanine to thymidine D. conversion of 5-methyl-THF to THF by the conversion of homocysteine to methionine

20. conversion of 5-methyl-THF to THF by conversion of homocysteine to methionine

5. The liver stores enough folate to meet daily requirement needs for how long? A. 1 month B. 6-8 weeks C. 2 years D. 3-6 months

3-6 months

3. A urinary methylmalonic acid determination is a sensitive diagnostic test for: A. folic acid deficiency B. intrinsic factor deficiency C. cobalamin deficiency D. homocysteine increase

3. cobalamin deficiency

3. Which of the disorders below results in ineffective erythropoiesis? (Hint: Objectives 1 and 3) A. hemolytic anemia B. liver disease C. hypothyroidism D. pernicious anemia

3. pernicious anemia

4. Which of the following conditions is an acquired deficiency of intrinsic factor function? A. autoantibodies to parietal cells B. gastrectomy C. autoantibodies to the IF-B12 complex D. bowel resection

4. gastrectomy

4. A Schilling test gives the following results: Part I: 2% excretion of radioactive B12. Part II: 8% excretion of radioactive B12 after intrinsic factor was given with B12. These results indicate: (Hint: Objectives 8 and 11) A. pernicious anemia B. blind-loop syndrome C. transcobalamin deficiency D. tropical sprue

4. pernicious anemia

5. All of the following are characteristics of megaloblastic anemia EXCEPT: A. hypersegmented neutrophils B. macrocytic erythrocyte indices C. elevated reticulocyte count D. pancytopenia

5. elevated reticulocyte count

5. A hemolytic anemia can become macrocytic if accompanied by: A. reticulocytosis B. target cells C. spherocytes D. elliptocytes

5. reticulocytosis

6. All of the following are typical RBC morphological findings for a person with megaloblastic anemia EXCEPT: (Hint: Objective 10) A. Burr cells B. Howell-Jolly bodies C. NRBCs D. macroovalocytes

6. Burr cells

7. Macrocytosis with a megaloblastic marrow can be accompanied by which of the following diagnostic characteristics? A. pancytopenia B. folate deficiency C. intramedullary destruction of blood cell precursors D. all of the above

7. all of the above

7. A patient was hospitalized with a moderate chronic anemia, jaundice, and neurological symptoms. His laboratory work-up demonstrated the following results: WBC: 3.5 x 109/L MCV: 110 fL RBC: 3.3x1012/L Hb: 11.0 g/dL Hct: 34% MCH: 33 pg MCHC: 33.0 g/dL Retics: 0.4% Plt: 100 x 10 Significant findings on the differential were: Moderate hypersegmented neutrophils 5 NRBCs/100 WBCs RBC morphology: Macrocytes 2+ Aniso 3+ Poikilo 2+ Ovalocytes 1+ Basophilic stippling 1+ Occasional Howell-Jolly body A bone marrow aspirate revealed an erythroblastic hyperplasia and megaloblastic normoblasts. Based upon the hematological findings, the most probable diagnosis is: A. iron-deficiency anemia B. von Willebrand's disease C. pernicious anemia D. chronic blood loss

7. pernicious anemia

8. In pernicious anemia, a variety of autoantibodies can be produced that are directed against: (Hint: Objectives 5 and 7) A. parietal cells and erythrocyte receptors for THF B. intrinsic factor-B12 complex and folic acid C. intrinsic factor and parietal cells D. intrinsic factor and folic acid

8. intrinsic factor and parietal cells

8. Folic acid deficiency and cobalamin deficiency both result in megaloblastic anemia with many of the same symptoms and laboratory test results. In the differential diagnosis of the two, which clinical symptom or laboratory test result is unique to the cobalamin deficiency associated with pernicious anemia and can be used to distinguish it from folate deficiency? A. neurologic manifestations B. macrocytosis C. pallor, weakness, light-headedness, and shortness of breath D. slight jaundice

8. neurologic manifestations

9. Cobalamin absorption from the small intestine into the circulation is affected by: (Hint: Objective 4) A. intrinsic factor and gastric pH B. intrinsic factor and folate C. gastrointestinal pH and amount of dietary folate D. amount of cobalamin and folate ingested

9. intrinsic factor and gastric pH

9. An abnormal Schilling test, Part I, would indicate which of the following? A. dietary B12 deficiency B. folic acid deficiency C. pernicious anemia D. vitamin B6 deficiency

9. pernicious anemia

8. Laboratory diagnosis of pernicious anemia can include which of the following? A. urinary FIGLU B. WBC count C. gastric analysis D. LDh

C. gastric analysis

9. Which type of congenital dyserythropoietic anemia (CDA) presents with giant multinucleated erythrocytes in the marrow? A. CDA I B. CDA II C. CDA III D. CDA IV

CDA III

7. A deficiency of cobalamin leads to impaired: A. folic acid synthesis B. DNA synthesis C. intrinsic factor secretion D. absorption of folate

DNA synthesis

1. most common cause of macrocytosis is: A. folate deficiency B. alcoholism C. liver disease D. pernicious anemia

Liver Disease

2. Which laboratory tests are most sensitive to decreased levels of cobalamin? A. red cell and serum folate B. serum cobalamin and red cell folate C. transcobalamin assays D. MMA and homocysteine

MMA and homocysteine

3. In megaloblastic anemia, increased intramedullary destruction of RBC precursors leads to: A. iron-deficiency anemia B. hemorrhage C. reticulocytosis D. a decreased M:E ratio in the bone marrow

a decreased M:E ratio in the bone marrow

5. Folic acid deficiency can be caused by: A. alcoholism B. chronic blood loss C. strict vegetarian diet D. vitamin B6 deficiency

alcoholism

1. This finding is highly specific for a diagnosis of pernicious anemia: A. autoantibodies to parietal cells B. autoantibodies to intrinsic factor C. autoantibodies to the IF-B12 complex D. achlorhydria of gastric juice

autoantibodies to intrinsic factor

8. If a patient excretes *7.5% of a radioactively tagged crystalline B12 dose after 24 hours both before and after administration of a dose of oral intrinsic factor, which of the following is a possible diagnosis? A. pernicious anemia B. liver disease C. gastrectomy D. celiac disease

celiac disease

5. Cobalamin plays an important role in DNA synthesis by the: A. transfer of one-carbon compounds from donor to acceptor molecules B. methylation of dietary folate to N5-methyl THF C. conversion of glycine to serine D. conversion of 5-methyl-THF to THF

conversion of 5-methyl-THF to THF

2. In North America, folate deficiency is most commonly due to: A. liver disease B. autoantibodies against IF C. diet D. intestinal blind-loop syndrome

diet

1. A 52-year-old homeless male was checked into the hospital suffering from fatigue and alcoholism. His CBC revealed that he was anemic. His blood smear revealed macro-ovalocytes, hypersegmented PMNs, Howell-Jolly bodies, and NRBCs. A serum cobalamin and Schilling test were normal. The blood smear is shown below. What is the most likely cause of this anemia? A. pernicious anemia B. hemolytic anemia with shift reticulocytosis C. dietary folate deficiency D. congenital dyserythropoietic anemia

dietary folate deficiency

10. A 48-year-old Caucasian female experiencing fatigue, loss of appetite, and weight loss over a period of three months was seen by her physician. A medical history revealed she had a history of alcohol abuse. An initial laboratory workup demonstrated that she was anemic, had a leukocyte count of 3 * 10 9/L, and had an MCV of 119 fL. Macro-ovalocytes and neutrophil hypersegmentation were noted on her blood smear evaluation. Based on the initial laboratory test results, her physician obtained a serum cobalamin and folate workup. Results were as follows: Serum cobalamin 550 pg/mL Serum folate 4.0 ng/mL RBC folate 105 ng/mL Based on her clinical history and laboratory results, the best possible diagnosis is which of the following? A. pernicious anemia B. folate deficiency C. primary cobalamin deficiency D. anemia of liver disease

folate deficiency

9. Alcoholic individuals commonly develop a macrocytic anemia due to: A. folate deficiency B. increased blood cholesterol levels C. development of autoantibodies against intrinsic factor D. intestinal malabsorption of cobalamin

folate deficiency

1. If a patient presents with anemia, macrocytosis, pancytopenia, and malnutrition, which of the following should be investigated first as a possible cause of the anemia? A. pernicious anemia B. folic acid deficiency C. cobalamin deficiency D. celiac disease

folic acid deficiency

4. Increases in urinary excretion of formiminoglutamic acid (FIGLU) most likely indicate which of the following? A. cobalamin deficiency B. autoantibodies to intrinsic factor C. folic acid deficiency D. hemolysis

folic acid deficiency

6. A lack of intrinsic factor could be due to: A. gastrectomy B. cobalamin deficiency C. folate deficiency D. large bowel resection

gastrectomy

3. Which of the following is the best clue in diagnosing megaloblastic anemia? A. decreased hemoglobin and hematocrit B. leukocytosis C. hypersegmented neutrophils D. poikilocytosis

hypersegmented neutrophils

3. Which of the following can be found in a patient with megaloblastic anemia? A. giant metamyelocytes and hypolobulated neutrophils B. howell-Jolly bodies and pappenheimer bodies C. hypersegmented neutrophils and oval macrocytes D. hypochromic macrocytes and thrombocytosis

hypersegmented neutrophils and oval macrocytes

2. In the majority of cases, cobalamin deficiency is due to a deficiency of: A. intrinsic factor B. vitamin B6 C. folate D. methylmalonic acid

intrinsic factor

3. Which of the following is a macrocytic/normochromic anemia associated with abnormal DNA metabolism? A. megaloblastic anemia B. hypothyroidism C. chronic hemolysis with reticulocytosis D. anemia of liver disease

megaloblastic anemia

5. A Schilling test gives the following results: Part I—2% excretion of radioactive cobalamin; Part II—8% excretion of radioactive B12 after intrinsic factor was given with cobalamin (reference interval: 7-10%). These results indicate: A. tropical sprue B. transcobalamin deficiency C. blind-loop syndrome D. pernicious anemia

pernicious anemia

6. Which of the following conditions increases the daily requirement for cobalamin? A. pregnancy B. aplastic anemia C. hypothyroidism D. splenectomy

pregnancy

7. Which of the following is more typical of nonmegaloblastic than megaloblastic anemia? A. oval macrocytes B. round macrocytes C. howell-Jolly bodies D. hypersegmented neutrophil

round macrocytes

10. Anemia due to liver disease is often associated with which of the following RBC morphological forms? A. ovalocytes B. microcytes C. spur cells D. teardrop cells

spur cells

2. All of the following are typical RBC morphologic findings for a person with megaloblastic anemia, EXCEPT: A. target cells B. Howell-Jolly bodies C. hypersegmented PMNs D. MCV of 110fl

target cells

4. A deficiency in cobalamin or folic acid results in ineffective erythropoiesis because they are necessary for: A. thymidylate synthesis B. transport of intrinsic factor to the erythroid marrow C. the uptake of iron into erythroid cells D. synthesis of erythropoietin by the kidneys

thymidylate synthesis

4. The metabolic function of tetrahydrofolate is to: A. synthesize methionine B. transfer carbon units from donors to receptors C. serve as a cofactor with cobalamin in the synthesis of thymidylate D. synthesize intrinsic factor

transfer carbon units from donors to receptors