Hematology 03: Megaloblastosis

Front 1

main problem in megaloblastosis is ___

Back 1

lack of nuclear maturation

Front 2

Hb in megaloblastosis is may be ___ or ___. MCV is ___, MCH is ___, and MCHC is ___.

Back 2

very low
normal
high
high
normal

Front 3

because of ___ there is pancytopenia in megaloblastosis.

Back 3

inefficient hematopoiesis

Front 4

in megaloblastosis RBCs are characterized by ___ (3), neutrophils by ___.

Back 4

oval macrocytosis
poikilocytosis
anisocytosis
hypersegmentation

Front 5

hemolysis in megaloblastosis causes elevated ___ (2)

Back 5

LDH
indirect bilirubin

Front 6

causes of hemolysis in megaloblastosis (2)

Back 6

ineffective erythropoiesis
diminished peripheral RBC survival

Front 7

5 hematologic conditions which cause macrocytosis

Back 7

megaloblastosis
reticulocytosis
MDS
aplastic anemia
marrow infiltration

Front 8

2 kinds of disease associated with macrocytosis

Back 8

liver
lung

Front 9

dietary factor associated with macrocytosis

Back 9

alcohol

Front 10

2 endocrine conditions associated with macrocytosis

Back 10

hypothyroidism
pregnancy

Front 11

anatomic change associated with macrocytosis

Back 11

asplenism

Front 12

time in life associated with macrocytosis

Back 12

newborn

Front 13

4 causes of megaloblastosis

Back 13

folate deficiency
B12 deficiency
drugs
inborn errors of metabolism

Front 14

___ makes UDP into dUDP

Back 14

ribonucleotide reductase

Front 15

___ makes dUMP into dTMP. it requires ___ as a cofactor. a drug which inhibits this enzyme irreversibly is ___. the other product of the reaction is ___.

Back 15

thymidylate synthetase
N5, N10 methylene THF
5-fluorouracil
dihydrofolate

Front 16

___ makes DHF into THF. 3 drugs which inhibits this enzyme are ___

Back 16

dihydrofolate reductase
MTX
pyrimethamine
aminopterin

Front 17

homocysteine may be metabolized to ___ (2)

Back 17

cystathionine
methionine

Front 18

homocystine may be made into methionine by ___ or ___. both perform ___ reactions.

Back 18

methionine synthetase
betaine methionine methyltransferase
methylation

Front 19

methionine synthetase takes a methyl from ___, which receives one from ___.

Back 19

methylcobalamine
5 Me THF

Front 20

methionine can be metabolized to ___ to by ___. the other reactant is ___.

Back 20

s-adenosyl methionine (SAM)
SAM synthetase
ATP

Front 21

SAM loses its methyl group to become ___.

Back 21

S-adenosyl homocysteine (SAH)

Front 22

SAH is made into homocysteine by ___

Back 22

SAH hydrolase

Front 23

___ makes homocysteine into cystathionine. it requires ___ (2)

Back 23

cystathionine synthetase
B6
Ser

Front 24

the body requires ___ of folate per day. it stores ___, which is enough for ___ months.

Back 24

100 ug
10 mg
4

Front 25

4 foods high in folate
boiling ___s the folate they contain.

Back 25

liver
yeast
greens
nuts
destroys

Front 26

folate is absorbed at ___ (2)

Back 26

duodenum
proximal jejunum

Front 27

3 metabolic steps required before folate can be absorbed

Back 27

deconjugation to monoglutamate
reduction
methylation

Front 28

deconjgation of folate is done by

Back 28

folate conjugase

Front 29

reduction of folate is done by ___, located in ___.

Back 29

THF reductase
mucosal cells

Front 30

4 causes of folate deficiency

Back 30

poor nutrition
malabsoption
increased folate demand
antifolate drugs

Front 31

T/F: HF can cause folate malabsorption

Back 31

true

Front 32

4 GI conditions associated with folate malabsorption

Back 32

celiac
sprue
Crohn's
jejunal resection

Front 33

2 times in life associated with increased folate requirements

Back 33

pregnancy
prematurity

Front 34

3 non-neoplastic hematological conditions associated with increased folate requirements

Back 34

hemolytic anemia
sideroblastic anemia
myelofibrosis

Front 35

3 inflammatory conditions associated with increased folate requirements

Back 35

RA
psoriasis
TB

Front 36

4 anticonvulsant drugs associated with decreased folate

Back 36

barbiturates
alcohol
diphenylhydantoin
primidone

Front 37

___ drugs inhibit folate synthesis by ___ (enzyme). an example is ___ aka ___

Back 37

sulfonamides
dihydropteroate synthetase
trimethoprim-sulfamethoxazole
septrin

Front 38

4 effects of folate deficiency

Back 38

megaloblastosis
glossitis
mouth ulceration
neural tube defects

Front 39

folate level in body is most accurately reflected by ___ and less accurately by ___.

Back 39

RBC folate
serum folate

Front 40

5 causes of high serum folate

Back 40

B12 deficiency
blind loop syndrome
folic acid therapy
hydrolyzed sample
infected blood sample

Front 41

2 causes of low RBC folate

Back 41

folate deficiency
B12 deficiency

Front 42

2 reactions using B12

Back 42

homocysteine -> methionine
methylmalonyl CoA -> succinyl CoA

Front 43

in a state of B12 deficiency, THF is trapped in serum as ___ and can't become ___.

Back 43

N5-methyl THF
THF

Front 44

2 markers of B12 deficiency

Back 44

high homocysteine
high methyl malonic acid

Front 45

3 foods with B12

Back 45

meat
liver
dairy

Front 46

daily requirement of B12 is ___. body stores ___, enough for ___, in ___.

Back 46

1--2 ug
3--5 mg
3--5 years
liver

Front 47

___ in the saliva binds ingested B12

Back 47

R-protein

Front 48

R-protein is degraded by ___ in the ___. after this, B12 is bound by ___ secreted by ___.

Back 48

pancreatic proteases
duodenum
intrinsic factor
gastric parietal cells

Front 49

the epithelium of ___ expresses a receptor called ___ for the ___ complex

Back 49

ileum
cubilin
IF-B12

Front 50

deficiency of transcobalamin 1 causes ___ but no ___.

Back 50

low serum B12
tissue B12 deficiency

Front 51

deficiency of transcobalamin 2 causes ___ but no ___.

Back 51

tissue B12 deficiency
low serum B12

Front 52

transcobalamin 1 is for ___
transcobalamin 2 is for ___

Back 52

B12 transport in serum
B12 transport from gut to tissue

Front 53

transcobalamin 1 is aka

Back 53

haptocorrin

Front 54

___ is the most common cause of B12 deficiency

Back 54

pernicious anemia

Front 55

pernicious anemia causes ___ gastritis

Back 55

atrophic

Front 56

pernicious is more common in men/women

Back 56

women

Front 57

3 characteristics of type I pernicious anemia

Back 57

anti-parietal cell Abs
achloridia
hypergastrinemia

Front 58

parietal cells secrete ___ and are located in the ___ of the stomach.

Back 58

acid
IF
body/fundus

Front 59

zymogen cells secrete ___ and are located in the ___ of the stomach

Back 59

pepsinogen
body/fundus

Front 60

gastrin-producing cells are in the ___ of the stomach

Back 60

antrum

Front 61

4 neuro effects of B12 deficiency

Back 61

peripheral neuropathy
subacute combined degeneration
retrobulbar neuritis
mental changes

Front 62

subacute combined degeneration means

Back 62

demyelination of dorsal and dorsolateral columns of SC

Front 63

anti-parietal cell Abs are ___% sensitive and are yes/no specific for PA.
anti-IF Abs are ___% sensitive and are yes/no specific for PA.

Back 63

90
no
55
yes

Front 64

2 kinds of anti IF Abs

Back 64

blocking
binding

Front 65

blocking Abs prevent

Back 65

B12 binding to IF

Front 66

binding Abs prevent

Back 66

ileal absorption

Front 67

___ test can diagnose PA

Back 67

Schilling

Front 68

4 endocrine disorders associated with PA

Back 68

thyroid toxicosis
DM
addison's
hypo-PTH

Front 69

2 neoplasms associated with PA

Back 69

gastric adenocarcinoma
gastric carcinoid

Front 70

3 oral effects of B12 deficiency

Back 70

glossitis
angular stomatitis
mucous membrane atrophy

Front 71

infertility in B12 deficiency is caused by ___ secondary to ___.

Back 71

hypercoagulability
hyperhomocysteinemia