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Crohn disease after ileal resection — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Crohn disease after ileal resectionUSMLE Step 3

A 45-year-old woman with Crohn disease had terminal ileal resection 2 years ago. She now has fatigue, paresthesias, glossitis, and macrocytosis. Folate is normal. Which of the following is the most likely explanation for this patient's findings?

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Correct answer: C — Vitamin B12 deficiency

The terminal ileum absorbs vitamin B12; ileal Crohn disease or resection can cause B12 deficiency with macrocytosis and neurologic symptoms.

Reference: ACG Crohn Disease Guideline