[MCQs] Megaloblastic Anemias- Part 3

I. Start the exam by click the “Start” button

Megaloblastic Anemias- Part 3

Please wait while the activity loads.
If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.

If loading fails, click here to try again

Start

Congratulations - you have completed Megaloblastic Anemias- Part 3. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

Your answers are highlighted below.

Question 1

Earliest neurologic manifestation of cobalamin deficiency is ?

A	Numbness and paresthesia in extremities
B	Motor weakness
C	Ataxia
D	Sphincter disturbances

Question 1 Explanation:

Signs and symptoms of cobalamin deficiency include numbness and paresthesia in the extremities (the earliest neurologic manifestations), weakness, and ataxia. There may be sphincter disturbances

Question 2

Neutrophils nucleus of >=6 lobes is suggestive of ?

A	Megaloblastic anemia
B	CML
C	AML
D	Multiple myeloma

Question 2 Explanation:

Hypersegmented nuclei of neutrophils is a characteristic finding of megaloblastic anemia. A single cell with a nucleus of six lobes or more raises suspicion of a megaloblastic anemia

Question 3

Which of the following provides evidence of ineffective erythropoiesis ?

A	Reduced haptoglobins
B	Positive urine hemosiderin
C	Raised serum lactate dehydrogenase
D	All of the above

Question 3 Explanation:

Raised urine urobilinogen, reduced haptoglobins and positive urine hemosiderin, and a raised serum lactate dehydrogenase provides evidence of ineffective erythropoiesis.

Question 4

What value of MCV is diagnostic of megaloblastic anemia ?

A	> 80 fL
B	> 90 fL
C	> 100 fL
D	> 110 fL

Question 4 Explanation:

Significant and marked macrocytosis (MCV > 100 fL) suggests presence of a megaloblastic anemia. Macrocytosis is less marked with concurrent iron deficiency or thalassemia. Reticulocyte index is low, & leukocyte and platelet count may also be decreased, particularly in severely anemic patients. PBF shows marked anisocytosis & poikilocytosis, with macroovalocytes, which are large, oval, fully hemoglobinized erythrocytes typical of megaloblastic anemias.

Question 5

Causes of macrocytosis include all except ?

A	Hemolysis
B	Aplastic anemia
C	Liver disease
D	Hyperthyroidism

Question 5 Explanation:

Macrocytosis occurs in hemolysis, liver disease, alcoholism, hypothyroidism & aplastic anemia.

Question 6

Megaloblastoid morphologic picture of RBC series is seen in ?

A	Hemolysis
B	Pernicious anemia
C	Myelodysplasia
D	All of the above

Question 6 Explanation:

Myelodysplasia produces a distinct morphologic picture most apparent in orthochromatic normoblasts in which a megaloblastic nucleus is associated with severely hypochromic cytoplasm. This variant is called “megaloblastoid” meaning presence of both nuclear & cytoplasmic maturation defects. “Megaloblastoid” does not mean “mildly megaloblastic.

Question 7

Megaloblastic anemia is seen in all except ?

A	Hereditary TC I deficiency
B	TC II deficiency
C	Orotic aciduria
D	Imerslund-Grasbeck disease

Question 8

Which of the following is not a finding in bone marrow examination in folate or B12 deficiency megaloblastic anemia ?

A	Hypercellularity
B	Increased myeloid / erythroid ratio
C	Nuclear-cytoplasmic asynchrony in RBC precursors
D	Fenestrated nuclear chromatin in RBC precursors

Question 8 Explanation:

In B 12 deficiency megaloblastic anemia, bone marrow is hypercellular with decreased myeloid / erythroid ratio & abundant stainable iron. RBC precursors are abnormally large & have nuclei that appear much less mature than would be expected from the development of cytoplasm (nuclearcytoplasmic asynchrony). Nuclear chromatin is more dispersed & it condenses in a peculiar fenestrated pattern that is very characteristic of megaloblastic erythropoiesis. Abnormal mitoses may be seen. Granulocyte precursors are also affected appearing as giant bands and metamyelocytes. Megakaryocytes are decreased & show abnormal morphology.

Question 9

Incidence of pernicious anemia is increased in ?

A	Graves’ disease
B	Myxedema
C	Thyroiditis
D	All of the above

Question 10

Incidence of pernicious anemia is increased in ?

A	Addison’s disease
B	Vitiligo
C	Hypoparathyroidism
D	All of the above

Question 10 Explanation:

Incidence of pernicious anemia is increased in patients with other diseases of immunologic origin like Graves’ disease, myxedema, thyroiditis, Addison’s disease, vitiligo & hypoparathyroidism.

Question 11

Which of the following about pernicious anemia is false ?

A	Gastric atrophy does not affect antrum of stomach
B	90% of patients have antiparietal cell antibody
C	~80% of patients have anti-IF antibody
D	None of the above

Question 11 Explanation:

None of the above

Question 12

Which of the following about pernicious anemia is false ?

A	Hypergastrinemia
B	Hypergastrinemia
C	Relatives have increased incidence of disease
D	It is uncommon in patients with agammaglobulinemia

Question 12 Explanation:

PA is associated with hypogammaglobulinemia, with premature graying or blue eyes, and in persons of blood group A. Gastric output of hydrochloric acid, pepsin, and IF is severely reduced. Serum gastrin level is raised, and serum pepsinogen I levels are low

Question 13

Which of the following is false about pernicious anemia ?

A	Rare under the age of 30 years
B	Average age of presentation is 60 years
C	Men more affected than women
D	Caused by the absence of IF

Question 13 Explanation:

Pernicious anemia is the most common cause of cobalamin deficiency. It is caused by absence of IF, due to atrophy of gastric mucosa or autoimmune destruction of parietal cells. Ratio of incidence of PA in men and women among whites is 1:1.6. Average age of presentation is 60 (disease of elderly) & is rare < 30 years of age.

Question 14

Which of the following about pernicious anemia is false ?

A	Unusually common in agammaglobulinemia
B	Helicobacter pylori infection is infrequent
C	Gastric atrophy spares the antrum
D	None of the above

Question 14 Explanation:

Pernicious anemia is unusually common in patients with agammaglobulinemia. Helicobacter pylori does not cause parietal cell destruction in pernicious anemia. Most characteristic finding in pernicious anemia is gastric atrophy affecting the acid- and pepsin-secreting portion of the stomach while sparing the antrum

Question 15

Which of the following about pernicious anemia is false ?

A	Gastric epithelium atypia common
B	Hypergastrinemia common
C	Gastric polyps common
D	None of the above

Question 15 Explanation:

Abnormalities in gastric epithelium appear as cellular atypia that must be distinguished from cytologic abnormalities of gastric malignancy. Hypergastrinemia & pentagastrin-fast achlorhydria occur secondary to gastric atrophy. Incidence of gastric polyps & stomach cancer is increased

Question 16

Which of the following about juvenile pernicious anemia is false ?

A	Gastric atrophy
B	Achlorhydria
C	Serum IF antibodies present
D	Parietal cell antibodies present

Question 16 Explanation:

In Juvenile PA, gastric atrophy, achlorhydria and serum IF antibodies are present, but parietal cell antibodies are usually absent

Question 17

Removal of what length of terminal ileum causes malabsorption of cobalamin ?

A	0.2 meter
B	0.5 meter
C	0.8 meter
D	1.2 meter

Question 17 Explanation:

Removal of 1.2 meters of terminal ileum causes malabsorption of cobalamin.

Question 18

Disease due to mutation in cubulin receptor leading to selective defect in cobalamin absorption is ?

A	Stickler syndrome
B	Imerslund-Gräsbeck Syndrome
C	Cogan’s syndrome
D	Menkes’ syndrome

Question 18 Explanation:

Imerslund-Gräsbeck syndrome is a congenital disorder (autosomal recessive) of selective defect in cobalamin absorption accompanied by nonspecific proteinuria but renal functions are normal. Mutation occurs in cubulin receptor that mediates intestinal absorption of cobalamin-IF complex. Patients have normal amounts of IF & gastric acid as are other tests of intestinal absorption.

Question 19

Combined deficiencies of cobalamin and folic acid is seen in which of the following conditions ?

A	Gastric achlorhydria
B	Tropical sprue
C	Regional enteritis
D	Pregnancy

Question 19 Explanation:

Combined deficiencies of cobalamin & folic acid is seen in tropical sprue. Gastric achlorhydria produces cobalamin deficiency by malabsorption due to defective release of cobalamin from food. Regional enteritis produces cobalamin deficiency by malabsorption due to terminal ileum malfunctioning. Pregnancy produces folate deficiency due to increased requirements.

Question 20

Fish tapeworm - D. latum causes megaloblastic anemia due to ?

A	Defective release of cobalamin from food
B	Inadequate production of intrinsic factor (IF)
C	Competition for cobalamin
D	Intestinal stasis

Question 20 Explanation:

Megaloblastic anemia or cobalamin neuropathy is seen in persons heavily infested by fish tapeworm, Diphyllobothrium latum, due to competition by the worm for cobalamin. Individuals acquire the worm by eating raw or partly cooked fish. Destruction of the worm eliminates the problem.

Question 21

Infestations by fish tapeworm “Diphyllobothrium latum” is common in which of the following countries ?

A	South East Asia
B	Scandinavia
C	South Africa
D	South Africa

Question 21 Explanation:

Individuals acquire fish tapeworm, Diphyllobothrium latum by eating raw or partly cooked fish. Infestation is common around the lakes of Scandinavia, Germany, Japan, North America & Russia

Question 22

Acute megaloblastic anemia can be seen after ?

A	Nitrous oxide anesthesia
B	Halothane anesthesia
C	Chloroform anesthesia
D	Ether anesthesia

Question 22 Explanation:

Nitrous oxide irreversibly oxidizes methylcobalamin to an inactive precursor which inactivates methionine synthase

Question 23

Malabsorption of folate is seen with which of the following drugs ?

A	Salazopyrine
B	Cholestyramine
C	Triamterene
D	All of the above

Question 23 Explanation:

Malabsorption of folate occurs in patients receiving salazopyrine, cholestyramine & triamterene. Antifolate drugs include anticonvulsant drugs (phenytoin, primidone, barbiturates), sulphasalazine, Nitrofurantoin, and tetracycline.

Question 24

Neonatal folate level falls rapidly to the lowest values at ?

A	6 weeks of age
B	12 weeks of age
C	24 weeks of age
D	32 weeks of age

Question 24 Explanation:

Neonatal folate level falls rapidly to the lowest values at about 6 weeks of age.

Question 25

Folic acid deficiency is due to ?

A	Inadequate intake
B	Increased demand
C	Malabsorption
D	All of the above

Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results

There are 25 questions to complete.

←

List

→

Return

Shaded items are complete.

1	2	3	4	5
6	7	8	9	10
11	12	13	14	15
16	17	18	19	20
21	22	23	24	25
End

Return

See all quizzes of the Megaloblastic Anemias at here:

Megaloblastic Anemias – Part 1 | Megaloblastic Anemias – Part 2 | Megaloblastic Anemias – Part 3 | Megaloblastic Anemias – Part 4

II. Preview all questions below

1.Earliest neurologic manifestation of cobalamin deficiency is ?
A. Numbness and paresthesia in extremities
B. Motor weakness
C. Ataxia
D. Sphincter disturbances

2. Neutrophils nucleus of >=6 lobes is suggestive of ?
A. Megaloblastic anemia
B. CML
C. AML
D. Multiple myeloma

3. Which of the following provides evidence of ineffective erythropoiesis ?
A. Reduced haptoglobins
B. Positive urine hemosiderin
C. Raised serum lactate dehydrogenase
D. All of the above

4. What value of MCV is diagnostic of megaloblastic anemia ?
A. > 80 fL
B. > 90 fL
C. > 100 fL
D. > 110 fL

5. Causes of macrocytosis include all except ?
A. Hemolysis
B. Aplastic anemia
C. Liver disease
D. Hyperthyroidism

6. Megaloblastoid morphologic picture of RBC series is seen in ?
A. Hemolysis
B. Pernicious anemia
C. Myelodysplasia
D. All of the above

7. Megaloblastic anemia is seen in all except ?
A. Hereditary TC I deficiency
B. TC II deficiency
C. Orotic aciduria
D. Imerslund-Grasbeck disease
8.Which of the following is not a finding in bone marrow examination in folate or B12 deficiency megaloblastic anemia ?
A. Hypercellularity
B. Increased myeloid / erythroid ratio
C. Nuclear-cytoplasmic asynchrony in RBC precursors
D. Fenestrated nuclear chromatin in RBC precursors

9. Incidence of pernicious anemia is increased in ?
A. Graves’ disease
B. Myxedema
C. Thyroiditis
D. All of the above

10. Incidence of pernicious anemia is increased in ?
A. Addison’s disease
B. Vitiligo
C. Hypoparathyroidism
D. All of the above

11. Which of the following about pernicious anemia is false ?
A. Gastric atrophy does not affect antrum of stomach
B. 90% of patients have antiparietal cell antibody
C. ~80% of patients have anti-IF antibody
D. None of the above

12. Which of the following about pernicious anemia is false ?
A. Hypergastrinemia
B. Pentagastrin-fast achlorhydria
C. Relatives have increased incidence of disease
D. It is uncommon in patients with agammaglobulinemia

13. Which of the following is false about pernicious anemia ?
A. Rare under the age of 30 years
B. Average age of presentation is 60 years
C. Men more affected than women
D. Caused by the absence of IF

14. Which of the following about pernicious anemia is false ?
Harrison’s 18th Ed. 867
A. Unusually common in agammaglobulinemia
B. Helicobacter pylori infection is infrequent
C. Gastric atrophy spares the antrum
D. None of the above

15. Which of the following about pernicious anemia is false ?
A. Gastric epithelium atypia common
B. Hypergastrinemia common
C. Gastric polyps common
D. None of the above

16. Which of the following about juvenile pernicious anemia is false ?
A. Gastric atrophy
B. Achlorhydria
C. Serum IF antibodies present
D. Parietal cell antibodies present

17. Removal of what length of terminal ileum causes malabsorption of cobalamin ?
A. 0.2 meter
B. 0.5 meter
C. 0.8 meter
D. 1.2 meter

18. Disease due to mutation in cubulin receptor leading to selective defect in cobalamin absorption is ?
A. Stickler syndrome
B. Imerslund-Gräsbeck Syndrome
C. Cogan’s syndrome
D. Menkes’ syndrome

19. Combined deficiencies of cobalamin and folic acid is seen in which of the following conditions ?
A. Gastric achlorhydria
B. Tropical sprue
C. Regional enteritis
D. Pregnancy

20. Fish tapeworm – D. latum causes megaloblastic anemia due to ?
A. Defective release of cobalamin from food
B. Inadequate production of intrinsic factor (IF)
C. Competition for cobalamin
D. Intestinal stasis

21. Infestations by fish tapeworm “Diphyllobothrium latum” is common in which of the following countries ?
A. South East Asia
B. Scandinavia
C. South Africa
D. South America

22. Acute megaloblastic anemia can be seen after ?
A. Nitrous oxide anesthesia
B. Halothane anesthesia
C. Chloroform anesthesia
D. Ether anesthesia

23. Malabsorption of folate is seen with which of the following drugs ?
A. Salazopyrine
B. Cholestyramine
C. Triamterene
D. All of the above

24. Neonatal folate level falls rapidly to the lowest values at ?
A. 6 weeks of age
B. 12 weeks of age
C. 24 weeks of age
D. 32 weeks of age

25. Folic acid deficiency is due to ?
A. Inadequate intake
B. Increased demand
C. Malabsorption
D. All of the above

[MCQs] Megaloblastic Anemias- Part 3

I. Start the exam by click the “Start” button

Megaloblastic Anemias- Part 3

See all quizzes of the Megaloblastic Anemias at here:

II. Preview all questions below

Share this:

Related

[MCQs] Megaloblastic Anemias – Part 2

[MCQs] Megaloblastic Anemias – Part 4

You may also like

Leave a Comment Cancel Reply