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| 3975533056 | What was the historic "extrinsic factor"? | Vit B12 | 0 | |
| 3975533057 | What is cobalamin and coenzyme B12? | Both are names for Vit B12 | 1 | |
| 3975533058 | Where is Vit B12 made? | by microorganisms | 2 | |
| 3975533059 | What are the dietary sources of Vit B12? | liver, glandular tissue, muscle, eggs, diary products, seafood | 3 | |
| 3975533060 | What is the body storage level of Vit B12? How much is used daily? | stores 2-5 mg, and use 2-5 ug (0.1%) | 4 | |
| 3975533061 | Where is B12 absorbed? | only in the terminal ileum | 5 | |
| 3975533062 | What two reactions does Vit B12 mediate? | (1) methyl transfer: methylation of homocystein to generate methionine. crucial for dividing tissues (like blood cell progenitors) (2) hydrogen transfer: generation of succinyl coA , crucial for myelin maintenance (explains neurological symptoms) | 6 | |
| 3975533063 | What is the most frequent cause of B12 deficiency? | malabsorption: due to salivary gland dysfunction, loss of intrinsic factor (gastric), pancreatic disease, terminal ileum illness, IBS | 7 | |
| 3975533064 | Can B12 deficiency be caused by congenital deficiency states or inadequate ingestion? | yes, but it is very rare | 8 | |
| 3975533065 | What are the 3 main clinical features of pernicious anemia? | Gastric atrophy (no folds), megaloblastic anemia, neurological degeneration (demyelenation) | 9 | |
| 3975533066 | What does the bone marrow of pernicious anemia pts look like? | huge bone marrow cells - megaloblasts | 10 | |
| 3975533067 | What would a CBC and blood smear reveal with pernicious anemia? | hemolysis because megaloblasts are dying in the bone marrow, thrombocytopenia, leukopenia, | 11 | |
| 3975533068 | What clinical/lab findings are specific to Vit B12 deficiency? | low serum B12 levels (<200) Peripheral and central nervous system disease methylmalonic acidemia elevated gastric pH | 12 | |
| 3975533069 | What's the difference between TC1 and TCII B12? | TC II B 12 -- is biologicallly useful! TCII can have a B12 analogue, though TCI can't be absorbed. | 13 | |
| 3975533070 | Under what conditions can serum B12 levels read falsely normal? | intestinal bacterial overgrowth, liver disease, myeloid disorders | 14 | |
| 3975533071 | Under what conditions can serum B12 be falsely low? | pregnancy, lymphoid disorders, ageing, racial differences | 15 | |
| 3975533072 | What is the most reliable marker for Vit B12 deficiency? | MMA (methylmalonic acid) | 16 | |
| 3975533073 | What is the therapy for Vit B12 deficiency? | B12 injections monthly for a lifetime | 17 | |
| 3975533074 | T/F: there can be lots of variation in the presence of neurologic manifestations with Vit B12 deficiency. | true | 18 | |
| 3975533075 | What is Tropical Macrocytic anemia? | an anemia identical to B12 deficiency but not associated with atrophic gastritis or neurologic disease | 19 | |
| 3975533076 | What synthesizes folic acid? | higher plants and microorganisms | 20 | |
| 3975533077 | How much folic acid do you store? How much do you use daily? Where is folate stored? | store 5 mg and use about 50 ug. Both folate and Vit B12 are stored in the liver | 21 | |
| 3975533078 | What are some dietary sources of folate? | leafy greens, asparagus, broccoli, spinach, liver, kidney, fruits, mushrooms | 22 | |
| 3975533079 | How folic acid transformed, from the time it enters the body? | dietary folate is mostly in methylated form. it is deconjugated in the intestine before absorption. It is reduced to N5-methyl tetrahydrofolate (FH4), and once in the tissues, it is polyglutamated | 23 | |
| 3975533080 | How do folate and Vit B12 interface? | Vit B12 is there to allow methioniine syntase to convert 5-methyl TH4 folate to TH4 folate | 24 | |
| 3975533081 | What are the consequences of folate deficiencies? | poor DNA synthesis. Get uracil misincorporation into DNA, leading to DNA strand breaks and cell cycle arrest... that is why you get macrocytosis. | 25 | |
| 3975533082 | Is folate deficiency anemia micro or macrocytic? | macrocytic, because of problem with DNA synthesis, and those cells being stuck in that phase of the cell cycle | 26 | |
| 3975533083 | T/F: both folate and B12 deficiency result in systemic disease and neuropathy | false! neurological disorders result from B12, not folate, deficiencies | 27 | |
| 3975533084 | What are the causes of folate deficiency? | inadequate ingestion (very common), inadequate absorption, metabolic block in utilization, increased requirement | 28 | |
| 3975533085 | How do you assess short term folate levels? Long term folate levels? | Short term : serum folic acid levels (< 3 ng/mL is bad) Long term/chronic: red cell folate levels (<135 ng/mL is bad) | 29 | |
| 3975533086 | Besides folate levels, what other metabolite can suggest folate deficiency? | high levels of homocysteine... but how elevated matters (normal is 4-12... for folate deficiency its 15-50, and for B12 deficiency its 20 - 241) | 30 | |
| 3975533087 | B12 or folate deficiency: megaloblastic anemia? | both | 31 | |
| 3975533088 | B12 or folate deficiency: combined system degeneration? | B12 | 32 | |
| 3975533089 | B12 or folate deficiency: poor diet associated with deficiency state? | B12 - rare; folate - common | 33 | |
| 3975533090 | B12 or folate deficiency: other dietary deficiencies present? | folate | 34 | |
| 3975533091 | B12 or folate deficiency: dietary source? | B12: muscle, liver, milk, eggs Folate: liver, leafy greens | 35 | |
| 3975533092 | B12 or folate deficiency: deficiency induces high homocystein? | both | 36 | |
| 3975533093 | B12 or folate deficiency: site of absorption? | B12: terminal ileum folate: all small bowel | 37 | |
| 3975533094 | B12 or folate deficiency: intrinsic factor required? | B12 | 38 | |
| 3975533095 | B12 or folate deficiency: deficiency associated with high methylmalonic? | B12 only | 39 |
