g*******n
发帖数: 319 | 1 A 69-year-old woman comes to the physician because of worsening dyspnea on
exertion and easy fatigubility. Her symptoms began several years ago but
have been progressively affecting her daily acitivities. Her other medical
problems include hypertension. Her past surgical history includes meningioma
removal and a total abdominal hysterectomy. She eats a balanced diet. Test
of the stool for occult blood is negative. Laboratory evaluation reveals a
hemoglobin level of 9.6mg/dl. Which of the following supplements is most
likely require parenteral administration in this patient?
A. Iron
B. Folic acid
C. Vit B12
D. Vit C
E. Protein
The answer is C. Can anybody tell me how to get the clues of B12 deficiency (most likey malabsorption)-induced anemia from the stem? Obviously she has a low hemoglobin level and dyspnea as well as fatigubility, but is there any other indication in her history contributing to B12 malabsorption?
Thanks! |
g*******n
发帖数: 319 | 2 Just go over the question again, I think the history or HTN, meningioma and
hysterectomy are all distracors. It feels like that the question actually is
asking about oral administration vs parenteral administration. Since the
other choices are all orally administrated so the answer is C? I am not 100%
sure about it. Waiting for the others' opinion... |
m******e
发帖数: 574 | 3 I think you get it right.
vitb12 - ivdrip |
x********o
发帖数: 181 | 4 请问这是哪一科学的内容啊？
and
is
100%
【在 g*******n 的大作中提到】
: Just go over the question again, I think the history or HTN, meningioma and
: hysterectomy are all distracors. It feels like that the question actually is
: asking about oral administration vs parenteral administration. Since the
: other choices are all orally administrated so the answer is C? I am not 100%
: sure about it. Waiting for the others' opinion...
|
g*******n
发帖数: 319 | |
g*******n
发帖数: 319 | 6 Thanks, Memorize!
【在 m******e 的大作中提到】
: I think you get it right.
: vitb12 - ivdrip
|
b****e
发帖数: 227 | 7 for pernicious anemia,
use vitB12 IM deep subQ. |
L****n
发帖数: 12932 | 8 The key to this question is the prominence of symptom inconsistant with
degree of anemia (9.x).
★ Sent from iPhone App: iReader Mitbbs 6.81 - iPhone Lite |
b****e
发帖数: 227 | 9 病人没有pernicious anemia的risk factor阿?
查了查药典,vitbB12 deficiency的话,B12可以nasal,oral or IM补,
那给药途径也不是解题的关键了.
several years的病程,应该比急性失血耐受更低的Hb
9.x的Hb症状应该是什么样呢?
没有临床经验,敬请蒙古大夫进一步解答.
多谢阿~~
【在 L****n 的大作中提到】
: The key to this question is the prominence of symptom inconsistant with
: degree of anemia (9.x).
: ★ Sent from iPhone App: iReader Mitbbs 6.81 - iPhone Lite
|
s********o
发帖数: 3319 | 10 我觉得主要还是选项里别的都是口服给药就行，只有B12在恶性贫血时肠道吸收不好所
以最可能肠道外给药。
这是哪里来的题？都不记得了
meningioma
Test
【在 g*******n 的大作中提到】
: A 69-year-old woman comes to the physician because of worsening dyspnea on
: exertion and easy fatigubility. Her symptoms began several years ago but
: have been progressively affecting her daily acitivities. Her other medical
: problems include hypertension. Her past surgical history includes meningioma
: removal and a total abdominal hysterectomy. She eats a balanced diet. Test
: of the stool for occult blood is negative. Laboratory evaluation reveals a
: hemoglobin level of 9.6mg/dl. Which of the following supplements is most
: likely require parenteral administration in this patient?
: A. Iron
: B. Folic acid
|
|
|
A*******s
发帖数: 9638 | 11 The key is 69 years old age plus anemia.
The diagnosis is Vitamin B12 deficiency anemia, not Pernicious anemia.
Pernicious anemia is an autoimmune disease, seen more in younger age.
Vitamin B12 deficiency anemia includes Pernicious anemia, but also includes
other causes. In this case, old age is the clue.
In practice, if you check medicare patient routinely for Vit B12 level, you
will be surprised to see how common people have B12 deficiency.
Hope this helps.
【在 s********o 的大作中提到】
: 我觉得主要还是选项里别的都是口服给药就行，只有B12在恶性贫血时肠道吸收不好所
: 以最可能肠道外给药。
: 这是哪里来的题？都不记得了
:
: meningioma
: Test
|
d****y
发帖数: 2180 | 12 好像是 UW Qbank.
【在 s********o 的大作中提到】
: 我觉得主要还是选项里别的都是口服给药就行，只有B12在恶性贫血时肠道吸收不好所
: 以最可能肠道外给药。
: 这是哪里来的题？都不记得了
:
: meningioma
: Test
|
b****e
发帖数: 227 | 13 谢谢蝎子版主和Aplusplus
includes
you
【在 A*******s 的大作中提到】
: The key is 69 years old age plus anemia.
: The diagnosis is Vitamin B12 deficiency anemia, not Pernicious anemia.
: Pernicious anemia is an autoimmune disease, seen more in younger age.
: Vitamin B12 deficiency anemia includes Pernicious anemia, but also includes
: other causes. In this case, old age is the clue.
: In practice, if you check medicare patient routinely for Vit B12 level, you
: will be surprised to see how common people have B12 deficiency.
: Hope this helps.
|
s********o
发帖数: 3319 | 14 哇这么客气，呵呵
要不你去查查恶性贫血的高发年龄是年轻的还是老的，如果是年轻的就不用说了，如果
是年老的咱们就大炒特炒，给Aplusplus前辈一个下马威 LOL
【在 b****e 的大作中提到】
: 谢谢蝎子版主和Aplusplus
:
: includes
: you
|
s********o
发帖数: 3319 | 15 哦 我原来担心是NBME或者CD上的
【在 d****y 的大作中提到】
: 好像是 UW Qbank.
|
d****y
发帖数: 2180 | 16 也有可能是NBME的。嘿嘿
【在 s********o 的大作中提到】
: 哦 我原来担心是NBME或者CD上的
|
s********o
发帖数: 3319 | 17 如果是NBME或者CD上的应该在标题上注明，很多人没做过的还指着拿它来预测成绩
【在 d****y 的大作中提到】
: 也有可能是NBME的。嘿嘿
|
g*******n
发帖数: 319 | 18 不好意思，忘记说是UW pharmacology的题目。不知道把UW解释copy在这里是否
appropriate，就不贴了吧。不过解释里面没有提及pernicious anemia，倒是把每个答
案的给药途径都提了一遍。其他选项都是口服给药，B12主要是肠外给药，B12口服给药
主要针对dietary deficiency, 而题干里这个病人是balanced dietary.
觉的Aplusplus前辈讲得挺对！我开始看UW解释的时候不得要领，看了楼
上各位的回帖再回去看，才豁然开朗。而且UW也提到绝大部分B12 deficiency是吸收障碍
造成，特别是老人由于胃酸少 （achlorhydria) 导致B12吸收障碍很常见。
恩，这样子理解应该是对了，多谢大家发言！！ |
b****e
发帖数: 227 | 19 查了查harrison's practice,
pernicious anemia:
*peak age of onset is 60,only 10% of patients are <40 yrs
**but in some ethnic group(black and latin american),age onset is lower
***typical pernicious anemia can occur in children under 10(juvenile
pernicious anemia)
PA常并发autuimmune diz,而autoimmune diz常见与年轻人,这么联系起来按说应该是年
轻人多发.不过PA挺有意思,incidence increase with age...
但是好伐年龄也因为种族而不同.不查还真不知道阿 |
D*****l
发帖数: 554 | 20 I am really impressed, "In practice, if you check medicare patient routinely
for Vit B12 level, you will be surprised to see how common people have B12
deficiency." Thank you.
includes
you
【在 A*******s 的大作中提到】
: The key is 69 years old age plus anemia.
: The diagnosis is Vitamin B12 deficiency anemia, not Pernicious anemia.
: Pernicious anemia is an autoimmune disease, seen more in younger age.
: Vitamin B12 deficiency anemia includes Pernicious anemia, but also includes
: other causes. In this case, old age is the clue.
: In practice, if you check medicare patient routinely for Vit B12 level, you
: will be surprised to see how common people have B12 deficiency.
: Hope this helps.
|
|
|
L****n
发帖数: 12932 | 21 Not to disagree with Aplus above, slight degree of anemia is very common in
old age people. However, symptom so severe (progressive worsening of fatigue
even to resting shortness of breathe) is unusual. That should direct u
toward the diagnosis of folic acid/b12 deficiency: different from common
form of anemia, its insult come from 2 sides, one, the hemoglobin level is
low, second, hemoglobin is less efficient (congregate into a big ball rather
than a donut, hence pernicious). Folic acid deficiency very unlikely in
people with balance diet without blood loss. B12 is a lot more common. IM
B12 is a double confirm to the answer of this question.
★ Sent from iPhone App: iReader Mitbbs 6.81 - iPhone Lite |
c*******s
发帖数: 399 | 22 Wow, thanks, everybody. I learn better from the personal teaching than
reading myself.
Let me ask another question, Why the patients with alcohol abuse tend to
have folic acid and vit b1 insufficiency?
in
fatigue
rather
【在 L****n 的大作中提到】
: Not to disagree with Aplus above, slight degree of anemia is very common in
: old age people. However, symptom so severe (progressive worsening of fatigue
: even to resting shortness of breathe) is unusual. That should direct u
: toward the diagnosis of folic acid/b12 deficiency: different from common
: form of anemia, its insult come from 2 sides, one, the hemoglobin level is
: low, second, hemoglobin is less efficient (congregate into a big ball rather
: than a donut, hence pernicious). Folic acid deficiency very unlikely in
: people with balance diet without blood loss. B12 is a lot more common. IM
: B12 is a double confirm to the answer of this question.
: ★ Sent from iPhone App: iReader Mitbbs 6.81 - iPhone Lite
|
A*******s
发帖数: 9638 | 23 I think you know the answer, don't you?
This has something to do with ETOH metablism.... Anybody wants to elaborate
?
【在 c*******s 的大作中提到】
: Wow, thanks, everybody. I learn better from the personal teaching than
: reading myself.
: Let me ask another question, Why the patients with alcohol abuse tend to
: have folic acid and vit b1 insufficiency?
:
: in
: fatigue
: rather
|
c*******s
发帖数: 399 | 24 No, I don't know the answer.
All chronic Alcoholics have malnutrition virtually due to lack of intake and
impaired absorption. My question is why folic acid and thiamins defficiency
are always addressed first,and treated promptly?
Some web search I did today:
folic acid deficiency: cause: 1.poor intake
2. ECHO dehydrogenase interferes the folic
acid utiliztion
thiamine: cause: poor intake and absorption |
A*******s
发帖数: 9638 | 25 ETOH is metabolized by alcoholdehydrogenase to acetaldehyde that in turn is
metabolized to acetate by aldehydehydrogenase. Acetate is finally broken to
CO2 and H2O in TCA cycle. Along its various metabolic steps, ETOH
metabolism requires Thiamine as a cofactor and this depletes rapidly.
and
defficiency
【在 c*******s 的大作中提到】
: No, I don't know the answer.
: All chronic Alcoholics have malnutrition virtually due to lack of intake and
: impaired absorption. My question is why folic acid and thiamins defficiency
: are always addressed first,and treated promptly?
: Some web search I did today:
: folic acid deficiency: cause: 1.poor intake
: 2. ECHO dehydrogenase interferes the folic
: acid utiliztion
: thiamine: cause: poor intake and absorption
|
c*******s
发帖数: 399 | 26 Thanks.
in short, on the top of poor intake , alcoholics have high
alcoholdehydragnase level which interferes the folic acid utiliaztion by
binding to folic acid; high ECHO metabalism depletes the thiamine, which
make the folic acid and thiamine deficiency more prominent than other
nutrients deficiency
is
to
【在 A*******s 的大作中提到】
: ETOH is metabolized by alcoholdehydrogenase to acetaldehyde that in turn is
: metabolized to acetate by aldehydehydrogenase. Acetate is finally broken to
: CO2 and H2O in TCA cycle. Along its various metabolic steps, ETOH
: metabolism requires Thiamine as a cofactor and this depletes rapidly.
:
: and
: defficiency
|
A*******s
发帖数: 9638 | 27 Nice summery.
【在 c*******s 的大作中提到】
: Thanks.
: in short, on the top of poor intake , alcoholics have high
: alcoholdehydragnase level which interferes the folic acid utiliaztion by
: binding to folic acid; high ECHO metabalism depletes the thiamine, which
: make the folic acid and thiamine deficiency more prominent than other
: nutrients deficiency
:
: is
: to
|
L****n
发帖数: 12932 | 28
i think you are one hell of teacher, do worth $1500 an hour, LOL.
【在 A*******s 的大作中提到】
: Nice summery.
|
s********o
发帖数: 3319 | 29 嗯 这么多年了居然还记得，不容易
不过有可能他是 google 找到的答案 LOL
【在 L****n 的大作中提到】
:
: i think you are one hell of teacher, do worth $1500 an hour, LOL.
|
A*******s
发帖数: 9638 | 30 你过奖了。
$1500 an hour，lol, you saw my post the other day?
【在 L****n 的大作中提到】
:
: i think you are one hell of teacher, do worth $1500 an hour, LOL.
|
|
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A*******s
发帖数: 9638 | 31 You are right this time. I did google for those enzymes.
你这次把你的场子找回去了，lol。
【在 s********o 的大作中提到】
: 嗯 这么多年了居然还记得，不容易
: 不过有可能他是 google 找到的答案 LOL
|
