Deck 21: Anemias Caused by Defects of DNA Metabolism

Question 1

Which of the following is normal in patients with pernicious anemia (PA)?

A)trypsin levels
B)intrinsic factor (IF)
C)stomach acid
D)absorption of vitamin B12

Answer 1

trypsin levels

Question 2

Which of the following is not associated with macrocytic red cells?

A)liver disease
B)iron deficiency anemia
C)megaloblastic anemia
D)myelodysplastic syndrome

Answer 2

iron deficiency anemia

Question 3

Which of the following would be an unusual finding in megaloblastic anemia?

A)marked polychromasia on the blood film
B)hypersegmented neutrophils
C)oval macrocytes
D)pancytopenia

Answer 3

marked polychromasia on the blood film

Question 4

Patients with vitamin B₁₂ or folate deficiency commonly experience symptoms related to

A)gastrointestinal and neurologic systems.
B)liver and lymph node enlargement.
C)skeletal and muscle problems.
D)kidney and bladder infections.

Question 5

Methotrexate and some other chemotherapeutic drugs work by

A)killing cancer cells with immune complexes.
B)competing with folate.
C)enhancing folate.
D)inhibiting vitamin B12 absorption.

Question 6

Why are the red cells larger than normal in megaloblastic anemia?

A)Concentration of erythropoietin is increased.
B)Release of reticulocytes is increased.
C)Cells are made larger because fewer of them exist.
D)Cell division is impaired.

Question 7

Which of the following bone marrow findings would be unexpected in megaloblastic anemia?

A)nuclear cytoplasmic asynchrony
B)giant bands and metas
C)hypercellularity
D)myeloid-to-erythroid (M:E) ratio of 10:1

Question 8

What is the most effective treatment for PA?

A)oral folate
B)injections of vitamin B12
C)oral vitamin B12
D)alterations in diet

Question 9

All of the following have increased need for folate except

A)patients on chemotherapy.
B)pregnant women.
C)infants and children.
D)male adults.

Question 10

Which of the following is true regarding hypersegmented neutrophils?

A)found in so many conditions that they are not significant
B)reported when neutrophils have four or more nuclear segments
C)are an early, consistent, and specific finding in megaloblastic anemia
D)usually accompany microcytic red cells

Question 11

Megaloblastic anemias are caused by a defect in the synthesis of

A)deoxyribonucleic acid (DNA).
B)ribonucleic acid (RNA).
C)erythropoietin.
D)heme.

Question 12

A patient with moderate anemia has an elevated MCV and hypersegmented neutrophils.Which of the following should be ordered first?

A)Schilling test
B)gastric analysis
C)antibodies to IF
D)vitamin B12 and folate assays

Question 13

Which of the following is decreased in megaloblastic anemia?

A)reticulocyte production index (RPI)
B)MCV
C)lactic dehydrogenase (LD)
D)bilirubin

Question 14

PA can be distinguished from folate deficiency by the

A)presence of hypersegmented neutrophils.
B)mean cell volume (MCV).
C)bone marrow findings.
D)presence of autoantibodies to IF.

Question 15

Which of the following tests for PA would be easiest for the patient?

A)vitamin B12 assay
B)bone marrow
C)gastric analysis
D)Schilling test

Question 16

Decreased folate is often associated with all of the following except

A)neural tube defects.
B)increased potassium.
C)microcytic anemia.
D)hyperhomocysteinemia.

Question 17

Which vitamins are required for the nuclear development of blood cells?

A)vitamin C and folate
B)vitamin B6 and folate
C)vitamin B12 and folate
D)vitamin B12 and D

Question 18

Which of the following is the best source of dietary vitamin B₁₂?

A)fruit
B)green vegetables
C)meat
D)legumes

Question 19

Which of the following is elevated in megaloblastic anemia?

A)white blood count
B)mean cell hemoglobin (MCH)
C)red blood count
D)platelet count

Question 20

A patient has a decreased vitamin B₁₂ assay.The Schilling test detects labeled vitamin B₁₂ in the urine when it is given with IF.What is the correct interpretation?

A)vitamin B12 assay probably incorrect
B)PA
C)vitamin B12 deficiency that is not PA
D)gastric analysis should be performed

Question 21

What salivary protein is important for the transport of dietary vitamin B₁₂ to the small intestine?

A)trypsin
B)IF
C)haptocorrin
D)transcobalamin II