1. A 55-year-old patient presents with fatigue, glossitis, and paraesthesia in the feet. Blood tests show macrocytosis with an MCV of 110 fL and low serum vitamin B12. What is the most likely diagnosis?
- A) Iron deficiency anaemia
- B) Folate deficiency anaemia
- C) Pernicious anaemia
- D) Aplastic anaemia
2. A 60-year-old female with known autoimmune thyroid disease reports increasing memory problems and difficulty walking. Her blood results reveal macrocytic anaemia and low vitamin B12. Which investigation would assist in confirming an autoimmune cause?
- A) Anti-gastric parietal cell antibody test
- B) Anti-intrinsic factor antibody test
- C) Serum ferritin
- D) Bone marrow biopsy
3. Patient receives hydroxocobalamin 1 mg intramuscularly on alternate days with neurological symptoms from B12 deficiency. After stabilisation, what is the usual maintenance dose?
- A) Hydroxocobalamin 1 mg daily
- B) Hydroxocobalamin 1 mg every 2 months
- C) Oral cyanocobalamin daily
- D) No further treatment needed
4. A 45-year-old vegan presents with fatigue and macrocytosis but no neurological symptoms. What is the initial step in management?
- A) Lifelong intramuscular vitamin B12
- B) Oral vitamin B12 supplementation
- C) Folate supplementation only
- D) No treatment needed
5. Which drug is known to cause vitamin B12 deficiency and mimic pernicious anaemia?
- A) Methotrexate
- B) Colchicine
- C) Metformin
- D) Nitrofurantoin
6. A patient with pernicious anaemia is undergoing follow-up. What feature warrants referral for a gastrointestinal endoscopy?
- A) Persistent anaemia
- B) New or worsening upper gastrointestinal symptoms
- C) Stable vitamin B12 levels
- D) Mild glossitis
7. Pernicious anaemia is most commonly caused by which underlying pathology?
- A) Autoimmune gastritis impairing intrinsic factor production
- B) Dietary vitamin B12 deficiency
- C) Ileal resection
- D) Chronic alcohol use
8. In pernicious anaemia, which neurological sign is commonly seen?
- A) Optic neuritis
- B) Symmetrical peripheral neuropathy affecting legs more than arms
- C) Cranial nerve palsies
- D) Myopathy
9. A 70-year-old who has undergone total gastrectomy presents with macrocytic anaemia. What is the recommended lifelong treatment?
- A) Lifelong intramuscular vitamin B12
- B) Oral folate
- C) Iron supplementation
- D) No supplementation
10. Which of the following is NOT a typical clinical sign of pernicious anaemia?
- A) Tachycardia
- B) Glossitis
- C) Weight loss
- D) Severe neuropathy is common in folate deficiency, but not pernicious anaemia
11. Which blood parameter is characteristically elevated in megaloblastic anaemia due to B12 deficiency?
- A) Haemoglobin
- B) Mean cell volume (MCV)
- C) Reticulocyte count
- D) Platelet count
12. When assessing a patient suspected of pernicious anaemia, which historical detail is most important to identify risk?
- A) Recent travel history
- B) Personal or family history of autoimmune disease
- C) Blood transfusion history
- D) Use of antibiotics
13. Which vitamin deficiency is associated with macrocytic anaemia, similar to pernicious anaemia, but lacks severe neuropathy?
- A) Iron deficiency
- B) Folate deficiency
- C) Vitamin D deficiency
- D) Vitamin C deficiency
14. Which lifelong management strategy is recommended for a patient with autoimmune gastritis causing pernicious anaemia?
- A) Lifelong intramuscular vitamin B12 replacement
- B) Intermittent oral folate
- C) Regular iron infusions
- D) No supplementation needed once anaemia resolves
15. Which neurological symptom is most specific to vitamin B12 deficiency in pernicious anaemia?
- A) Optic neuropathy
- B) Urinary incontinence
- C) Sensory ataxia with paraesthesia
- D) Myalgia
16. What is the significance of a negative anti-intrinsic factor antibody test in suspected pernicious anaemia?
- A) Confirms absence of autoimmune gastritis
- B) Does not rule out autoimmune gastritis
- C) Rules out vitamin B12 deficiency
- D) Indicates folate deficiency instead
17. In a patient with pernicious anaemia, which associated condition may also be present?
- A) Addison's disease
- B) Vitiligo
- C) Iron overload
- D) Celiac disease
18. How soon after starting vitamin B12 treatment might a patient with pernicious anaemia expect symptom improvement?
- A) Within 2 weeks but may take up to 3 months
- B) Immediately after first dose
- C) After 6 months of treatment
- D) Only after 1 year
19. Which of the following is a reversible cause of vitamin B12 deficiency that differs from pernicious anaemia?
- A) Autoimmune gastritis
- B) Recreational nitrous oxide use
- C) Total gastrectomy
- D) Terminal ileal resection
20. Which of the following drug histories should raise suspicion for vitamin B12 deficiency leading to pernicious anaemia?
- A) Long-term use of sulfasalazine
- B) Long-term use of proton pump inhibitors
- C) Recent antibiotics
- D) Short term corticosteroids