skip to main content

Pernicious Anaemia — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardHaematologyPernicious AnaemiaRACP Adult Medicine

A patient with autoimmune gastritis has gait ataxia, loss of vibration sense and macrocytic anaemia from confirmed vitamin B12 deficiency. Which replacement plan is most appropriate in Australia?

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

Reveal the answer and explanation

Correct answer: A — Use intramuscular hydroxocobalamin loading followed by lifelong intramuscular maintenance

Explanation lettering: C = shown as A · A = shown as B · E = shown as C · B = shown as D · D = shown as E

C is correct because neurological disease and irreversible malabsorption warrant prompt intramuscular loading followed by lifelong maintenance. D uses a route that current Australian guidance does not prefer for irreversible malabsorption. E risks treating folate while neurological B12 injury progresses and still uses unreliable oral maintenance. A makes transfusion the gateway to neurological treatment and retains the unsuitable oral route. B loads correctly but stops maintenance despite a permanent cause. Potassium and clinical response are monitored during brisk marrow recovery.

Reference: Australian Prescriber, Vitamin B12 deficiency: testing and treatment: https://australianprescriber.tg.org.au/articles/vitamin-B12-deficiency-testing-and-treatment.html