3 macrocytic b12 deficiency Flashcards

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