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Vitamin B12 Deficiency — UKMLA MCQ

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HardHaematologyVitamin B12 DeficiencyUKMLAMRCGP AKTPARAMRCP Part 1

A patient has confirmed vitamin B12 deficiency with sensory ataxia and impaired proprioception. There is no immediately reversible dietary cause. Which initial replacement pattern is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Intramuscular hydroxocobalamin until neurological recovery plateaus

The best answer is “Intramuscular hydroxocobalamin until neurological recovery plateaus”. Neurological involvement warrants parenteral hydroxocobalamin given frequently at first, traditionally on alternate days, until there is no further improvement, followed by maintenance according to cause. A fixed short course may undertreat ongoing neurological recovery. Folic acid alone can improve the blood count while neurological injury progresses.

Reference: NICE NG239: Vitamin B12 deficiency in over 16s: https://www.nice.org.uk/guidance/ng239/chapter/recommendations