PANCE Practice Question of the Week

A 25-year-old Scandnavian male presents with terrible discomfort after weeks of working in a lead-zinc mine. The symptoms include indigestion, belching, and diarrhea. His tongue is red and sore. He reports easy fatigability with minimal exertion, accompanied with difficulty breathing. Physical examination reveals high blood pressure and tachycardia. In addition, you observe splenomegaly, and pallor of the skin and mucus membrane. Peripheral blood smear examination indicates large oval RBCs, fragmented cells, hypersegmented neutrophils, and poikilocytosis.

Lab values reveal:

Hb, 9 g%; RBC count,

3.5 millions/cu mm of blood;

PCV, 39%; ESR,15 mm at the end of first hour ;

MCV, 110u3; Serum, Vit B12, 160 p mol/l, and non responsiveness of Histalog test.

Which of the below deficiencies, do these symptoms represent?

ANSWER CHOICES

A Dietary deficiency of Vit B12
B Intrinsic factor deficiency
C Defect in the site of absorption of Vit B12
D Folic acid deficiency
E Iron deficiency

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