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| 4658012820 | Vitamin B12 deficiency what type of anemia? | macrocytic | 0 | |
| 4658012821 | vitamin B12 deficiency B12 plays important role in - incidence increases with- | NEURO function age | 1 | |
| 4658012822 | B12 in what foods? (only source) | animal proteins dairy eggs shellfish fish | 2 | |
| 4658012823 | cobalamin absorption depends on | adequate diet intake acid-pepsin in stomach pancreatic proteases gastric secretion of intrinsic factor ileum w/ functional cobalamin-IF receptors | 3 | |
| 4658012824 | causes of vitamin B12 deficiency | inadequate diet (usually not the issue) malabsorption - *pernicious anemia* & others *other* H. pylori chronic pancreatitis zollinger-ellison syndrome HIV hereditary factors drugs | 4 | |
| 4658012825 | pernicious anemia | autoimmune destruction of parietal cells --> dec IF ===> malabsorption of B12 may be with other autoimmune d/o - thyroid, addison's vitiligo | 5 | |
| 4658012826 | other causes of malabsorption of B12 | gastrectomy/gastritis (total/partial, roux-en-Y) ileal resection (abs in terminal ileum) crohn's dz (ileal) fish tapeworm | 6 | |
| 4658012827 | hereditary B12 deficiency | transcobalamin deficiency usually presents within few weeks of birth | 7 | |
| 4658012828 | drugs that cause B12 deficiency | metformin (put on Ca2+ to avoid) PPIs | 8 | |
| 4658012829 | vit B12 def - clinical manifestations | general - glossitis NEURO - peripheral neuropathy (symmetrical, LE) ataxia (vibration, position), weakness PSYCH - irritability, depression, personality changes, memory impairment, dementia skeletal - osteoporosis | 9 | |
| 4658012830 | vit B12 def - diagnosis | CBC peripheral blood smear *vitamin B12* *methylmalonic acid* *homocysteine lvl* | 10 | |
| 4658012831 | vit B12 def CBC: mcv peripheral blood smear: | CBC: low Hgb, MCV >100, RDW inc (sizes vary) smear: macroovalocytes, lg oval erythrocytes, hypersegmented neutrophils | 11 | |
| 4658012832 | vitamin B12 normal = | >300 | 12 | |
| 4658012833 | borderline result = if borderline results... what should you do? | 200-300 order homocysteine lvl methylmalonic acid lvl | 13 | |
| 4658012834 | low = B12 value is consistent with deficiency | <200 | 14 | |
| 4658012835 | falsely low B12 | folate deficiency multiple myeloma pregnancy | 15 | |
| 4658012836 | falsely normal B12 | chronic liver dz myeloproliferative disorders chronic renal dz | 16 | |
| 4658012837 | if you suspect B12 def, what should also be checked for? | folate deficiency | 17 | |
| 4658012838 | B12 def methylmalonic acid = homocysteine lvl = | increased increased | 18 | |
| 4658012839 | which his increased with BOTH folate and B12 deficiency? | homocystiene lvl | 19 | |
| 4658012840 | increased methylmalonic acid can also be found in patients with | chronic renal insufficiency | 20 | |
| 4658012841 | methylmalonic acid & homocysteine lvls both normal = both increased = | vit B12 and folate deficiency ruled out B12 deficiency confirmed | 21 | |
| 4658012842 | autoimmune destruction of gastric parietal cells | pernicious anemia | 22 | |
| 4658012843 | pernicious anemia = increased risk of | gastric carcinoma 3x higher EGD to look for signs of cancer | 23 | |
| 4658012844 | pernicious anemia diagnosis | shilling test anti-intrinsic factor antibodies anti-parietal cell antibodies | 24 | |
| 4658012845 | HIGHLY confirmatory for diagnosis | anti-IF antibodies*** | 25 | |
| 4658012846 | shilling test | rarely used today distinguishes IF related malabsorption (location) | 26 | |
| 4658012847 | vit B12 deficiency treatment | tx underlying cause if possible vitamin B12 - IM or oral | 27 | |
| 4658012848 | B12 IM dose | 1 mg IM QD x 7 days, then 1 mg IM weekly x 4 weeks, then 1 mg monthly | 28 | |
| 4658012849 | oral B12 | 1000-2000 mcg/day | 29 | |
| 4658012850 | hemoglobin normalizes by | 2 months | 30 | |
| 4658012851 | neuro sx improve over | 3 months max @ 6-12 mo | 31 | |
| 4658012852 | B12 screening | no guidelines base on history, PE, risk factors (i.e. bypass) | 32 | |
| 4658012853 | where is folate found? | animal products leafy veggies fruits cereal & grains nuts | 33 | |
| 4658012854 | folate deficiency most commonly due to | malnutrition poor diet +/or alcoholism (alcohol inhibits abs) | 34 | |
| 4658012855 | where is folate stored? | liver stores last 2-4 months | 35 | |
| 4658012856 | drugs that can cause folate deficiency | methotrexate phenytoin trimethoprim | 36 | |
| 4658012857 | intestinal malabsorption | crohn's sprue | 37 | |
| 4658012858 | increased folate requirements | inflammatory dz - psoriasis exfoliative dermatitis RA crohn's | 38 | |
| 4658012859 | folate deficiency clinical manifestations | weakness glossitis fatigue weight loss NO neuro sx | 39 | |
| 4658012860 | folate deficiency diagnosis | folate level red cell folate homocysteine level | 40 | |
| 4658012861 | folate level: red cell folate: homocysteine level: | folate level: inc or dec (short-term reflection) **red cell folate: decreased homocysteine level: increased (methylmelonic acid NOT) | 41 | |
| 4658012862 | what is most reliable indicator of folate lvl? | red cell folate | 42 | |
| 4658012863 | folate deficiency treatment | tx underlying folic acid | 43 | |
| 4658012864 | folic acid dose | 1 mg/day 1-4 mo. or until complete hematologic recovery | 44 | |
| 4658012865 | IMPORTANT: rule out this BEFORE treating for folic acid | B12 deficiency | 45 |
