#Nbme sample questions answers trial

In this case, the patient’s history of Crohn disease should raise suspicion that impaired intestinal absorption of vitamin B12 is the cause of her anemia. Vitamin B12 deficiency can develop if any of these steps are impaired.

Successful absorption of vitamin B12 in the small intestine (particularly at the ileum).

Binding of B12 with intrinsic factor (produced by parietal cells within the gastric mucosa).

This is because the absorption of vitamin B12 requires several key aspects, including: Although this patient’s anemia did not improve with supplementation with vitamin B12, that does not rule out vitamin B12 deficiency as a cause of her anemia. Common causes of macrocytic anemia include:Īfter evaluating the MCV, possible correct answers include dietary folate deficiency and impaired intestinal absorption of vitamin B12. Here, the patient has an MCV > 100 μm3, pointing toward a macrocytic anemia. When approaching anemia questions on the USMLE, start by evaluating the mean corpuscular volume (MCV) as this will allow one to narrow down the list of possible answers. Hypersegmented neutrophils seen on peripheral blood smear Macrocytic anemia (mean corpuscular volume > 100 μm3) Lateral corticospinal tract → motor weakness Neurologic symptoms → subacute combined degenerationĭorsal columns → defects in proprioception positive Romberg sign Pancreatic insufficiency Diphyllobothrium latum (fish tapeworm)Īnemia often takes years to develop, given the large hepatic stores of vitamin B12Fatigue and generalized weakness Post gastrectomyPost gastric bypass surgery Lack of intrinsic factor (pernicious anemia) Intestinal malabsorption (eg, Crohn disease) Pancreatic insufficiency Answer Vitamin B12 (Cobalamin) Deficiency Impaired intestinal absorption of vitamin B12į. Decreased release of iron from macrophages due to chronic inflammationĮ. Complement mediated destruction of red blood cellsĬ. Which of the following is the most likely cause of this patient’s anemia?ī. Laboratory studies performed at that time show persistent anemia with a serum hemoglobin of 9.5 g/dL. The patient is prescribed oral vitamin B12 supplementation and advised to return to the clinic for follow-up in 1 month. Her vital signs are within normal limits. She rarely drinks alcohol and denies tobacco use. She eats a balanced diet that includes chicken, fish, pork, fruits, and vegetables. She is married and lives with her husband. She has a history of Crohn disease and hypertension for which she receives appropriate medications.

She used to walk 1 mile each evening but now gets tired after 1-2 blocks. First Step 1 Sample Question: AnemiaĪ 65-year-old woman presents to the office with generalized fatigue for the last 4 months.

#Nbme sample questions answers trial

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