QuestionSBA
QuestionChoice
No this is not the correct answer. Methotrexate inhibits the enzyme dihydrofolate reductase, leading to folate deficiency. Whilst this is a possible cause of macrocytic anaemia, this is not the single best answer as this patient is experiencing these symptoms due to Crohn's disease of the ileum.
10007854
e
Methotrexate use
QuestionChoice
No, this is not the correct answer. Although folate deficiency is another cause of macrocytic anaemia, it is absorbed from the duodenum and jejunum of the GI tract and thus is less likely to be impaired in crohn's disease.
10007851
b
Folate deficiency
QuestionChoice
No, this is not the correct answer. Although folate deficiency is another cause of macrocytic anaemia, it is absorbed from the duodenum and jejunum of the GI tract and thus is less likely to be impaired in crohn's disease.
10007853
d
Alcohol toxicity
QuestionChoice
Yes, this is the correct answer. The patient has an MCV > 100 fL which suggests macrocytic/megaloblastic anaemia. In terms of her symptoms, she has presented with subacute degeneration of the spinal cord secondary to B12 or folate deficienct. The way to differentiate between these two causes is by looking at the patient history. First of all there is no mention of her diet, hence it is already difficult to differentiate in terms of dietary intake. However, the stem mentions that she has crohn's disease particularly affecting the ileum area. We know that vitamin B12 is absorbed from the ileum (terminal) and that crohn's disease can result in malabsorption in the area of the GI tract affected, making this the most likely explanation for her symptoms.
10007850
a
Vitamin B12 deficiency
QuestionChoice
No, this is not the correct answer as iron is absorbed from the upper jejunum and duodenum. If this patient was iron deficient, they would also have microcytic anaemia, rather than macrocytic.
10007852
c
Iron deficiency
Concept
Chapter
2693
4040
Macrocytosis
Topic
157
Haematology
Vitamin B12 deficiency
14117
A 23-year-old woman with a previous medical history of Crohn's disease visits the GP for an annual check-up. She reports a sense of numbness and tingling in both her arms. In addition, she reports feeling quite fatigued which has been disrupting her work life. She denies any rectal bleeding.



A full blood count and blood film is requested



||||
|--------------|:-------:|---------------|
|Haemoglobin|78 g/L|(M) 130 - 170, (F) 115 - 155|
|Mean Cell Volume (MCV)|119 fL|80 - 96|
|Mean Cell Haemoglobin (MCH)|21 pg|27 - 33|
|Reticulocytes|19x10<sup>9</sup>/L|25 - 100|


A recent colonoscopy report notes that her Crohn's disease primarily affects her distal ileum.



The patient is otherwise fit and well, eating a balanced diet with minimal alcohol intake. She does not smoke.



Which of the following is the most likely cause of this patients symptoms?
a