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| 3272883604 | anemia is defined as an abnormally low number of circulating ____ or low concentration of ____. this results in diminished oxygen carrying capacity of the blood. | RBC hemoglobin | 0 | |
| 3272685002 | what does B 12 make? | RBC | 1 | |
| 3272887417 | vitamin b 12 is essential for the synthesis of ___ | DNA | 2 | |
| 3272740391 | what type of anemia is vitamin b 12 deficiency? | macrocytic and hypochromic | 3 | |
| 3272687240 | Vitamin B 12 deficency is an anemia which means you do not have enough RBC. What does this cause? | pt will feel weak and tired | 4 | |
| 3272689240 | deficient amounts of vitamin B 12 will cause ____ and _____ _____ injury | anemia nervous system | 5 | |
| 3272690245 | what can vitamin B 12 trigger? | pernicious anemia | 6 | |
| 3272691667 | Name 3 chief complaints of a pt with vitamin B 12 deficiency | problems talking and concentrating memory issues numbness in legs and trouble walking | 7 | |
| 3272693821 | what is the history and present illness of a patient with vitamin b12 deficiency? | -pallor and fatigue -difficulty concentrating and short term memory loss -bilateral lower extremity numbness -gait problems -tingling in hands and feet -peripheral neuropathy | 8 | |
| 3272701545 | difficulty with gait shows that there could be a problem with the ____ | cerebellum | 9 | |
| 3272792748 | do patients with vitamin b 12 deficiency typically have a problem with their cerebellum? | NO cerebellar problems is a differential diagnosis | 10 | |
| 3272703572 | Cerebellar symptoms show that the vitamin B 12 deficiency has progressed. How does the disease progress? | from peripheral to inward | 11 | |
| 3272706217 | patient was an alcoholic and a drug abuser. alcohol can cause the stomach lining to become aggregated. What can this cause? | decrease in vitamin b 12 absorption and folic acid absorption | 12 | |
| 3272711847 | Patients mother developed bacterial thyroiditis. Is bacterial thyroiditis a risk factor for vitamin B 12 deficiency? | YES | 13 | |
| 3272713582 | excessive alcohol and ____ use is a risk factor | cocaine | 14 | |
| 3272714745 | long history of ____ _____ is a risk factor. patient is not taking in enough vitamin b 12 | poor nutrition | 15 | |
| 3272716422 | Patients who are vegetarians and vegans lack what? | higher risk for lacking vitamin b 12 and folic acid | 16 | |
| 3272717591 | meat supplies you with what? | vitamin b 12 | 17 | |
| 3272717592 | vegetables supply you with what? | folic acid | 18 | |
| 3272720451 | what can be an initial sign of a patient with vitamin b 12 deficiency? | burning tongue (atrophic gloittis) | 19 | |
| 3272723233 | if your stomach lining is destroyed you may not be able to absorb ____ ____ which leads to malabsorption of it b 12 | intrinsic factor | 20 | |
| 3272725761 | what drug suppresses the production of stomach acid which will lead to the malabsorption of vit b 12? | OTC famotidine (treats heartburn) | 21 | |
| 3272727582 | patient who has a vitamin b 12 deficiency can present with | -malnourished -cognitive impairments -restless | 22 | |
| 3272730066 | patients BMI will most likely be ______. why? | underweight pt will typically be malnourished | 23 | |
| 3272732330 | pt's vital signs show a wide pulse pressure. What is this indicitive of? | -anemia -thyrotoxicosis | 24 | |
| 3272733588 | what can a widened pulse pressure eventually cause? | heart murmur | 25 | |
| 3272736731 | what will the patients skin look like? | pale with slight jaundice. patient is pale b/c they are deficient in RBC | 26 | |
| 3272745247 | what do the patients eyes present with? ___ ___ | sclera icterus | 27 | |
| 3272746531 | what is sclera icterus and what is it indicitive of? | jaudice in the eyes billiruben has crossed the BBB | 28 | |
| 3272749938 | what will the patients tongue look like? | beefy red tongue with glossitis. tongue will burn | 29 | |
| 3272752174 | _____ of the mucous membranes. This is because of decreased RBC | pallor | 30 | |
| 3272772037 | *why is there significant discomfort in the neck?* | spread to the spinal cord? | 31 | |
| 3272773777 | why is the systolic border best heard at the right sternal border? | because the Hct is less than 20% | 32 | |
| 3272774541 | why is there a murmur present? | increased pumping b/c of anemia | 33 | |
| 3272775181 | what else can cause the murmur? | cocaine. major affect of cocaine is vasoconstriction. this can cause angia and vasoconstriction of the brain | 34 | |
| 3272778270 | pts mental status will show | slow response time. mild loss of mental status | 35 | |
| 3272780927 | why is there a mild loss of mental status? | damage to the myelin sheath | 36 | |
| 3272841492 | vitamin b 12 plays an important role in developing the ____ _____ | myelin sheath | 37 | |
| 3272780928 | what five areas does the mental status test for? | orientation, registration, attention, calculation, recall/language | 38 | |
| 3272782448 | motor exam shows _____ results | mild results. 4/5 | 39 | |
| 3272783624 | why are there absent reflexes of the ankles? | disease of the spinal cord. there is damage to the myelin sheath | 40 | |
| 3272784603 | damage to the spinal cord and myelin sheath will cause what? | paraesthisia to the distal extremities | 41 | |
| 3272787173 | will the patient have a positive babinski? | YES | 42 | |
| 3272789535 | *because of the damage to the myelin sheath the sensory and motor pathways are messed up because of the damage to the spinal cord* | ANSWER TO ALL THINGS | 43 | |
| 3272790532 | what does the romberg test, test for? | proprioreception | 44 | |
| 3272796119 | pt will present with: -numb feet -slapping, pins and needles -foot drop -nerve damage -sensory loss | 45 | ||
| 3272797238 | LAB STUDIES | -Hb LOW -Hct LOW -RBC LOW -platelets LOW -WBC LOW -Reticulocytes LOW -MCV HIGH -MCH HIGH -Vit B 12 LOW -Folic Acid LOW -T billiruben HIGH -Billiruben indirect HIGH -Alb LOW -T protein LOW -LDL HIGH -MMA HIGH -homocystine HIGH | 46 | |
| 3272805398 | Why is the Hb and Hct low? | poor nutrition and alcohol abuse cannot absorb the vitamin b 12 based off of the serum antibodies | 47 | |
| 3272809074 | The reticulocytes are low because not enough RBC being _____. what does this mean? | produced Aplastic Anemia | 48 | |
| 3272809965 | MCV is high which indicates | Macrocytic anemia | 49 | |
| 3272810826 | MCH is high which means | Macrocytic blood vessels that have a higher concentration of hemoglobin on each RBC | 50 | |
| 3272812473 | why is the billiruben high? | b/c of the break down of hemoglobin | 51 | |
| 3272816001 | your body produces billiruben when it breaks down ____. Macrocytic cells have increased hemoglobin so when they break down the billiruben levels increase. | hemoglobin | 52 | |
| 3272817961 | Albumin is made in the ____ | liver | 53 | |
| 3272817962 | the albumin is low because | -poor nutriton -decreased stomach function | 54 | |
| 3272819992 | LDL is high is this related to the vitamin b 12 deficiency? | No, poor lifestyle habits | 55 | |
| 3272820726 | What is MMA | Methylmalonic Acid -specific test for vitamin b 12 | 56 | |
| 3272822786 | RBC are an abnormal size | anisocytosis | 57 | |
| 3272823157 | RBC are an abnormal shape | poikliocytosis | 58 | |
| 3272826764 | ____ ____ are indicitive of megablastic anemia of either vitamin b 12 deficency or folic acid deficiency. In megablastic anemia you have 6-8 lobes | hypersegmented neutrophils | 59 | |
| 3272828414 | pertinent negative that the serum antibodies showed ____ ____ and ____ ___ | intrinsic factor parietal cells | 60 | |
| 3272830076 | without ___ ___ vitamin b 12 cannot be absorbed | intrinsic factor | 61 | |
| 3272830634 | vitamin b 12 deficiency can cause ____ _____ | perncious anemia | 62 | |
| 3272834288 | the patient was negative for antibodies meaning he has intrinsic factor. Does this mean that the patient has pernicious anemia? | NOOOOO | 63 | |
| 3272836152 | If the patient is positive for intrinsic factor and parietal cells does this mean that the patient has pernicious anemia? | YES | 64 | |
| 3272843263 | ID 3 major risk factors that contributed to vitamin b 12 deficiency in this patient | -alcohol -poor nutrition -mom having hypothyroid | 65 | |
| 3272845528 | name 8 symptoms that are consistent with the diagnosis of vitamin b 12 deficiency | - difficulty concentratining -difficulty expressing -problems with memory -numbness in the periphery -trouble walking -unsteady in the dark -shooting pain in the neck (damage to myelin sheath) -poor nutrition -fatigue | 66 | |
| 3272849019 | ID 15 objective signs that correlate with the diagnosis of vitamin b 12 deficiency | - response time slow -pallor -mild jaundice -glossitis -diminshed sensations -slap foot - 4/5 on motor exam -positive babinski -absent ankle reflex -no temperature sensation -diminished pin prick sensation - loss of vibration - cannot stand with eyes closed (romberg test) | 67 | |
| 3272853166 | ID lab findings correlating with vitamin b 12 deficiency | - Low hg, hit, platelets, rbc, wbc, reticulocytes, vitamin b 12, folic acid -high MCV, MCH, billiruben indirect | 68 | |
| 3272856686 | is the patients renal function normal or abnormal? | normal because patients Bun and creatitin were normal | 69 | |
| 3272857606 | is the patients hepatic function normal? | abnormal because of high billiruben and low albumin | 70 | |
| 3272859438 | is the patients lipid panel normal? | no, HIGH LDL | 71 | |
| 3272860308 | does this patient have pernicious anemia? | no because he has negative ID and parietal cell antibodies | 72 | |
| 3272862234 | what type of anemia does this patient have? -megaloblastic anemia -neurological abnormalities -none of the above | megablastic anemia | 73 | |
| 3272865622 | medical term for "severe neck pain shooting down the back into the arms" _____ _____. what does this indicate? | cervical reticulopathy severe damage to the myelin sheath affecting the neck and the spinal cord | 74 | |
| 3272869830 | why does this patient has a slap foot? | because of weakness and paralysis of the extremities due to the loss of the myelin sheath | 75 | |
| 3272871731 | why is the significance of the romberg test in this patient? | tests the patients proprioreception, shows the patient has ataxia | 76 | |
| 3272873942 | need to differentiate vitamin b 12 deficiency from what? | folic acid deficiency | 77 | |
| 3272875389 | how do you treat this patient? | -IM vitamin b 12 injections and potassium -rehab for drug/alcohol abuse | 78 | |
| 3272894982 | READING | 79 | ||
| 3272895637 | prevalence of vitamin b 12 deficiency increase with ____ and _____ | age use of gastric acid blocking agents | 80 | |
| 3272897830 | human body stores _____ years worth of vitamin b 12. Symptoms of a deficiency will manifest in 3 years | 3-5 years | 81 | |
| 3272898542 | infants and children show symptoms more ___ | rapidly | 82 | |
| 3272901698 | -anorexia with weight loss -burning or soreness of the tongue with changes in taste -N/V -neurological symptoms -paraesthisa -symptoms can mimic Alzhemiers -psychotic manifestations -spinal cord damage | symptoms associated with vit b 12 deficiency | 83 | |
| 3272907487 | -strict vegetarian diet -chronic alcoholism | dietary insufficiency of vitamin b 12 | 84 | |
| 3272910042 | -surgical removal of stomach -chronic gastritis -use of histamine 2 blocking drugs or PPI -chronic pancreatitis | insufficent stomach acid or pancreatic enzymes to serape b 12 from ingested animal proteins or b12 binding proteins | 85 | |
| 3272914222 | -IF deficiency (pernicious anemia) -removal of terminal ileum -chrons -celiac -lakefish tapeworms -medications such as: cholestyramine, neomycin, metoformin, phenoformin, chlorine | impaired absorption of vitamin b 12 | 86 | |
| 3272916214 | cognetial deficiency of plasma protein carrier transcoblamin II | abnormality in the plasma transport of vitamin b 12 | 87 | |
| 3272918249 | *absence of intrinsic factor is the most common cause of vitamin b 12 deficiency in the US* | 88 | ||
| 3272921074 | major risk factors of vit b 12 deficiency | - positive FH of pernicious anemia -scandinavian or celtic descent -neuroendocrine disease, type 1 diabetes, addison disease, graves disease, hasimotis thyroiditis | 89 | |
| 3272927272 | "any process that impairs the ingestion, separation, absorption, plasma transport or transfer into cells of B12 may result in the clinical manifestation of a bit b12 deficiency* | 90 | ||
| 3272932394 | _____ _____ is characterized by an infiltration of lymphocytes within the walls of the stomach that is associated with degeneration of parietal cells and their replacement of goblet cells. This is known as intestinal metaplasia | perncious anemia | 91 | |
| 3272936852 | bone marrow biopsy will show: -marked red blood cell hypercellularity -megaloblastic in red and white blood cell lines | 92 | ||
| 3272937406 | + intrinsic factor and parietal cells indicate | PERNCIOUS ANEMIA | 93 | |
| 3272938455 | lymphocytes will appear in the walls of the ____ in pernicious anemia | stomach | 94 | |
| 3272943281 | what are reticulocytes? | immature blood cell without a nucleus | 95 | |
| 3272944799 | why is it reasonable to test the serum folic acid concentration in a patient who is suspected of having it b 12 deficiency | present with similar lab findings need to differentiate | 96 | |
| 3272961905 | what is alchlorhydira? | production of hydrochloric acid in gastric secretions is low in the stomach | 97 | |
| 3272963953 | why is achyloridia reasonable to find in patients with pernicious anemia? | because there is a commonly problems with the stomach lining in patients because of improper neutrition and alcohol | 98 | |
| 3272967508 | If the father of an unborn child has a single defective gene/mutation for transcobalamin II deficiency and the mother has two normal genes, what is the probability that their unborn child will be transcobalamin II deficient? | 99 | ||
| 3272968141 | If both the father and mother of an unborn child each have a single defective gene/mutation for transcobalamin II deficiency, what is the proba- bility that their unborn child will be transcobalamin II deficient? | 100 | ||
| 3272968142 | Why is it reasonable to find lymphocytes in the walls of the stomach in patients with pernicious anemia? | 101 | ||
| 3272971712 | type 1 diabetes mellitus | lack of serum insulin | 102 | |
| 3272971713 | addison disease | decrease serum cortisol | 103 | |
| 3272972154 | graves disease | increase serum thyroxine | 104 | |
| 3272972155 | hashimotos thyroiditis | decrease serum thyroxine | 105 | |
| 3272974419 | persistent aberrant beliefs or perceptions held invio- lable by a person despite evidence that refutes them | delusion | 106 | |
| 3272975765 | abnormal condition characterized by an elaborate, sus- picious system of thinking that is usually centered on one major theme, such as an unfaithful spouse, being poisoned, or being watched by outer space aliens | paranoia | 107 | |
| 3272976201 | abnormal sensory perceptions that can occur in any of the senses, do not result from an external stimulus, and occur in the waking state | hallucinations | 108 | |
| 3272779189 | why is there a mild loss of mental status? | damage to the myelin sheath | 109 |
