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| 2815360652 | 2 categories of macrocytic anemia | 1. megaloblastic 2. non-megaloblastic | 0 | |
| 2815363536 | failure of dna syntheisis is | megaloblastic | 1 | |
| 2815363537 | membrane abnormalities is | non magaloblastic | 2 | |
| 2816490804 | non meg anemia has abnormal ____ metabolism | cholesterol | 3 | |
| 2816491456 | what diseases accompany non meg anemia | 1. advanced liver disease 2. hypothyroidism | 4 | |
| 2816492425 | meg: cell cycle arrests in | S phase | 5 | |
| 2816492733 | what maturation doesn't occur in meg: | nuclear | 6 | |
| 2816493585 | meg has: 1. bizzare shaped ____ 2. ___, immature nuclei | 1. cells 2. large | 7 | |
| 2816494090 | meg is ____ | pancytopenic | 8 | |
| 2816496212 | meg: you have ___ effects such as GI sx and abnormal pap smears | systemic | 9 | |
| 2816500156 | ___ is a common clinical finding | macrocytosis | 10 | |
| 2816501935 | in patients seeking medical care for macro: MCV is | high | 11 | |
| 2816502310 | in patients seeking medical care for macro anemia: anemia is | not present | 12 | |
| 2820379227 | what causes neuro damage | percicious anemia | 13 | |
| 2820379629 | maco incidence is __ out of 1000 people | 2 | 14 | |
| 2820380931 | PA can appear ___ year before anemia begins | 1 | 15 | |
| 2820380932 | B 12 is essential for | 1. nervous system function 2. normal red, white, and platelet production 3. ** cofactor for methionin synthetase in conversion of homocysteine to methionine 4. conversion of meth-co A to succinyl CoA | 16 | |
| 2820383359 | if you have elevated homocysteine, you can lower it by ... | giving people extra b12 | 17 | |
| 2820383713 | sources of b12 in food | 1. dairy 2. eggs | 18 | |
| 2820385635 | daily absorption of b12 is | 5 mcg | 19 | |
| 2820386199 | b12 combines with ___ made by the parietal cells in the stomach | intrinsic factor | 20 | |
| 2820386645 | this combination makes them easily absorbably in the | terminal ileum | 21 | |
| 2820386646 | diet deficiency in b12 is very | rare | 22 | |
| 2820388925 | b12 must be bound to ____ for effieicnt absorption | intrinsic factr | 23 | |
| 2820389690 | what stores b12 | liver | 24 | |
| 2820389691 | how much b12 does the liver store | 2000 - 5000 mcg | 25 | |
| 2820390408 | deficency in b12 occurs ___ after cessation of b12 | > 3 years | 26 | |
| 2820392545 | any decreased production of intrinsic factor includes | 1. pernicious anemia 2. gastrectomy | 27 | |
| 2820392936 | the MOST COMMON CAUSE OF B12 DEF. IS | pernicious anemia | 28 | |
| 2820392937 | how do you get PA | sometimes hereditary | 29 | |
| 2820394626 | ___ infection also causes b12 def | helicobacter pylor infection | 30 | |
| 2820395363 | the ____ causes competition of b12 in the gut vs bacteria | blind loop syndrom | 31 | |
| 2820395364 | this competition can also be caused by | fish tapeworm | 32 | |
| 2820398355 | 6 causes of b12 def | 1. pancreatic insufficiency 2. decreased ileal absorption of b12 3. transcobalamin II defieicny 4. diet 5. agents that block absorption 6. alcoholism | 33 | |
| 2820398861 | pancreatic insufficiency is from | failure to inactivate competing cobalamin binding proteins | 34 | |
| 2820402271 | decreased ileal absorption of b12 is from | surgical resection crohns disease | 35 | |
| 2820404680 | trans. II def is the only protein carrier that | can transport b12 into cells (rare) | 36 | |
| 2820408151 | diet b12 def is from | strict vegetarians | 37 | |
| 2820408932 | what agents block b12 absorption | 1. neomycin 2. biguandies (metformin) 3. proton pump inhibitors ** | 38 | |
| 2820414212 | pernicious anemia is caused from | lack of intrinsic factor | 39 | |
| 2820414213 | PA is also known as | **combined systems disease | 40 | |
| 2820420165 | does PA fast or slow onset | slow | 41 | |
| 2820420166 | do you get hypovolemia with PA | NO | 42 | |
| 2820421563 | high risk groups for getting pa | 1. ileal disease 2. gastric disease 3. chronic PPI USE*** | 43 | |
| 2820422454 | **hallmark of symptomatic vit b12 def is ___ | megaloblastic anemia | 44 | |
| 2820423864 | at dx. PA may be | very anemia | 45 | |
| 2820424151 | in PA, hct can be | 10-15% | 46 | |
| 2820424827 | what is also common when PA is diagnosed in pt | 1. leukopenia (wbc) 2. thrombocytopenia (platelet) | 47 | |
| 2820427390 | sx of PA | 1. pale 2. icteric (jaundice) 3. mucosal cell changes 4. glossitis 5. GI distrubances 6. anorexia and diarrhea | 48 | |
| 2820428585 | neur sx in pa | peripheral nerve degeneration | 49 | |
| 2820429077 | what is sign of neuro disease in pa | symmetric paresthesias of feet AND hands | 50 | |
| 2820429660 | is neur early or late | late: so hard to fix | 51 | |
| 2820430253 | in PA, there is also degneration of the __ of the spinal cord | posterior columns | 52 | |
| 2820431010 | how to tell if pt has degeneration of the posterior columns | 1. bad vibratory sense 2. proprioception disturbances 3. spastic ataxia | 53 | |
| 2820431620 | what is ataxia | staggering gait | 54 | |
| 2820442379 | what are teh 5 cerebral signs of PA | 1. irritabilty 2. somnolence 3. memory impairment 4. perversion of taste, smell, vision 5. mental derangments | 55 | |
| 2820443286 | what is mental derangements also called**** | megaloblastic madness | 56 | |
| 2820450515 | cbc in PA looks like | large cell hyperchromic anemia abnormal cells | 57 | |
| 2820451317 | mcv in PA is | 110-140 fl | 58 | |
| 2820451850 | causes of normal MCV in PA | 1. early 2. coesisting iron def. or thalassemia 3. idiopathic 4. neuro and normal mcv and anemia needs eval. | 59 | |
| 2820456167 | also see ___ and ___ | 1. anisocytosis 2. poikilocytosis | 60 | |
| 2820456766 | anisocytosis is | presense of abnormally shaped cells | 61 | |
| 2820457352 | poiklocytosis | abnrormally shapd rbc | 62 | |
| 2820459902 | cbc: find ___ olalocytes in pa | macro | 63 | |
| 2820459903 | cbc pa: ____ neutrophils | hypersegmented | 64 | |
| 2820460790 | vit b12 is | essential for ALL cell lines | 65 | |
| 2820471795 | cbc in macro: decreased ___ count | reticulocyte | 66 | |
| 2820474391 | chemistries in b12 def are | 1. elevated serum lactase dehydrogenase 2. increased indirect bilirubin | 67 | |
| 2820478236 | how to dx b12 def | 1. HP 2. sx of anemia 3. neuro signs 4. lab | 68 | |
| 2820485861 | what do you need to make a dx of b12 def | 1. macrocytic anemia 2. megaloblastic blood smear 3. macro-ovalocytes 4. hypersegmented neutrophils 5. low serum v b12 levels | 69 | |
| 2820489907 | what test do you do FIRST for b12 def | get b12 blood level first b/c its easy and cheap | 70 | |
| 2820490698 | what will cbc show for b12 def | 1. anemia 2. high mcv 3. hypersegmented nuclei 4. +/- pancytopenia 5. low ret count 6. peripheral smear | 71 | |
| 2820494093 | if person has both b12 (or folate) def AND iron def then | they have normal or decreased rbc size***** | 72 | |
| 2820502651 | sx patients with b12 def will have serum cobalamin ___ | < 170 | 73 | |
| 2820503091 | PA can be dx by | anti intrinsic factor antibodies or anti parietal antibodies (first measure b12 level) | 74 | |
| 2820517241 | low b12 levels are difficult to interpret so dx PA by | measuring anti intrinsic factor and anti parietal antibodies | 75 | |
| 2820517606 | b12 levels Normally fall during ___ but doesn't produce disease | pregnancy | 76 | |
| 2820521185 | cbl levels: ____ means def is unlikely | > 240 | 77 | |
| 2820521771 | cbl levels: ____ means cbl def is possible | 170-240 | 78 | |
| 2820522346 | cbl levels: ___ means levels are consistent with cbl disease | < 170 | 79 | |
| 2820526584 | what is used to sort out borderline cases for b12 levels | serum methylmalonic | 80 | |
| 2820528008 | low or normal b12 levels should be confirmed with ___ testing | metabolite | 81 | |
| 2820528498 | why isn't metabolite testing used a lot | cost | 82 | |
| 2820536307 | metabolite testing shoud be reserved for those pts in whom a high degree of suspicion o cbl is | present | 83 | |
| 2820537916 | definitly use metabolite testing if pt is | 1. borderline levels 2. pts with neuro problems 3. cause of dementia | 84 | |
| 2820538624 | metabolite testing excludes | b12 def when levels are normal | 85 | |
| 2820544144 | what else do you order with the b12 test | FOLATE***** | 86 | |
| 2820544145 | TX OF B12: | oral 1000-2000 mcg of b12 daily | 87 | |
| 2820544821 | is oral as good as iv | yes | 88 | |
| 2820545295 | ___% is absorbed even without intrinsic factor | 1% | 89 | |
| 2820546064 | presence or absence of neuro damage is | critical in deciding method of therapy | 90 | |
| 2820546961 | tx of b12 def WITHOUT neuro sx | 1. b 12 iv then switch to oral | 91 | |
| 2820547407 | what is sequence of iv without neuro tx | 1000 mcg 1 /day for 1 week 1000 mcg / week for 1 month | 92 | |
| 2820550600 | when b12 hsa been restored, switch to ___ oral for life | 1-2 mg/day | 93 | |
| 2820554248 | b12 def tx WITH neuro sx | life long parenteral therapy | 94 | |
| 2820554667 | what is schedule for tx with neuro sx | 1000 mcg every day for 1 week 1000 mcg 1/week for 1 mont 1000 mcg 1/month for life | 95 | |
| 2820555601 | what if pt stops taking meds | they will be anemic again | 96 | |
| 2820556192 | how long does it take for meds to work | 1 week | 97 | |
| 2820556196 | how do you know therapy is working | see high reticulocytes in 5-7 days | 98 | |
| 2820556990 | hematolc pic normalizes in | 2 months | 99 | |
| 2820560163 | prognosis of b12 def | 1. hypokalemia if anemia is severe 2. cns is permanent if lasted more than 6 months | 100 |
