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Iron deficiency anemia — USMLE Step 2 CK MCQ

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HardInternal MedicineIron deficiency anemiaUSMLE Step 2 CK

A 56-year-old woman with autoimmune thyroid disease has fatigue, glossitis, and distal paresthesias. Hemoglobin is 9.8 g/dL, mean corpuscular volume is 112 fL, vitamin B12 is low, methylmalonic acid is elevated, and intrinsic-factor antibody is positive. Which additional evaluation is most appropriate after replacement begins?

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Correct answer: B — Upper endoscopy with systematic corpus and antral gastric biopsies

The best answer is “Upper endoscopy with systematic corpus and antral gastric biopsies”. Pernicious anemia reflects autoimmune corpus-predominant atrophic gastritis and carries risks of gastric adenocarcinoma and type 1 neuroendocrine tumors. Upper endoscopy with systematic biopsies confirms the diagnosis and extent and excludes prevalent neoplasia. Vitamin replacement is urgent but does not remove the need to evaluate the underlying gastric disorder.

Reference: AGA Clinical Practice Update: Atrophic Gastritis: https://pmc.ncbi.nlm.nih.gov/articles/PMC8740554/