Medplexus

41). A 48 year old man complains of fatique and shortness of breath. His Ht is 32%, and Hb - 103 g/l. Peripheral blood smear reveals macrocytosis. Serum vitamin B12 level is 90 pg/ml (normal is 170 to 940); serum folate level is 6 ng/ml (normal is 2 to 14). Possible causes to consider include all of the following EXCEPT: A. Colonic diverticulitis B. Vegetarianism C. Regional enteritis D. Pancreatitis E. Fish tapeworm infection Explanation :  Cause of vitamin B12 deficiency include:  Vegetarianism  (low dietary content),  Regional enteritis  (  B12 readily absorbed in the last part of the small intestine i.e ileum )  Pancreatitis  ( Vitamin B12 bind two carrier proteins haptocorrin [R binder] and intrinsic factor, but only its binding to intrinsic factor allows its absorption and R binder is removed by pancreatic enzyme which is defficient in pancreatitis ),  Fish tapeworm infection ( parasite absorbing 80% or more of the host's B12 intake ) 42). A 41 year old patient wa

31). A patient is  65  y.o. He has been a  smoker for 40 years . Hew has  lost 10 kg  during the last 3 months. Complains of pain in the epigastric area after taking meals, diarrhea, jaundice. Physical examination revealed  enlarged, painless gallbladder .  Feces are light-coloured  and clay-like. Blood analysis revealed increased level of whole and direct bilirubin, alkaline phosphotase and glutaminepyruvate transferase. Clinical urine analysis showed positive bilirubin reaction and negative urobilinogene reaction. Where is the initial process that caused these changes? A. In pancreas B. In common bile duct C. In liver D. In duodenum E. In gallbladder Explanation :  Feces is light color it means patient has obstructive jaundice that is caused by cancer developed on pancreatic head. Gallbladder enlarged due to bile flow obstruction by  pancreatic head  cancer. Elderly, smoking is risk factor.  weight  is alarm sign for cancer. 32). A 75 y.o. man has acute pain in the pa