1.
Which of the following findings suggest Cholestasis?
Correct Answer
C. Increase of ALP and GGT activity, high cbilirubin in serum
Explanation
The presence of an increase in ALP and GGT activity, along with high bilirubin levels in the serum, suggests cholestasis. Cholestasis refers to a condition where there is a reduction or blockage in the flow of bile from the liver, leading to the accumulation of bile salts and bilirubin in the bloodstream. ALP and GGT are enzymes that are commonly elevated in cholestasis, indicating liver dysfunction. Additionally, high bilirubin levels further support the diagnosis of cholestasis as bilirubin is a component of bile and its elevation suggests impaired bile flow.
2.
Choose the marker of Tumor metastasis
Correct Answer
E. CEA
Explanation
CEA stands for carcinoembryonic antigen. It is a marker that is commonly used to detect and monitor the presence of certain types of cancer, including colorectal, pancreatic, and lung cancer. Elevated levels of CEA in the blood can indicate the presence of cancer and can also be used to monitor the effectiveness of treatment and detect any recurrence or metastasis of the tumor. Therefore, CEA is the marker of tumor metastasis among the given options.
3.
Which of the following results suggest complete respiratory failure?
Correct Answer
C. (Low PO2, ^^ PCO2)
Explanation
The answer (Low PO2, ^^ PCO2) suggests complete respiratory failure because it indicates a low partial pressure of oxygen (PO2) and an elevated partial pressure of carbon dioxide (PCO2). In respiratory failure, the lungs are unable to effectively oxygenate the blood and remove carbon dioxide, leading to low levels of oxygen and high levels of carbon dioxide in the bloodstream. This can result from conditions such as severe asthma, chronic obstructive pulmonary disease (COPD), or acute respiratory distress syndrome (ARDS).
4.
Choose the best cardiac markers which are recommended to confirm acute heart failure:
Correct Answer
E. HsTroponin
Explanation
hsTroponin is the best cardiac marker recommended to confirm acute heart failure. Troponin is a protein found in cardiac muscle cells, and its release into the bloodstream indicates damage to the heart. The "hs" in hsTroponin stands for high-sensitivity, which means that it can detect even small amounts of troponin in the blood, making it a more accurate and sensitive marker for diagnosing acute heart failure compared to other cardiac markers like Troponin I, Troponin T, Myoglobin, and CK-MB.
5.
Choose the parameters of B12 deficiency anemia:
Correct Answer
E. MCV, MHC, MCHC, low
Explanation
The correct answer is MCV, MHC, MCHC, low. This is because in B12 deficiency anemia, the mean corpuscular volume (MCV) is typically high, while the mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) are low. These changes in the red blood cell indices are indicative of larger, paler red blood cells, which are characteristic of B12 deficiency anemia.
6.
Lymphocytosis is defined as:
Correct Answer
C. An increase in the lympHocyte count in peripHeral blood
Explanation
Lymphocytosis is defined as an increase in the lymphocyte count in peripheral blood. This means that there is a higher than normal number of lymphocytes, which are a type of white blood cell, circulating in the bloodstream. Lymphocytosis can be a sign of various conditions, including viral infections, autoimmune disorders, and certain types of leukemia. By identifying an increase in lymphocyte count, healthcare professionals can use this information to help diagnose and monitor these conditions.
7.
Which of the following laboratory parameters are used to confirm the severity of anemia:
Correct Answer
B. RBC, HGB, HCT
Explanation
The laboratory parameters RBC, HGB, and HCT are used to confirm the severity of anemia. RBC (Red Blood Cell count) measures the number of red blood cells in a given volume of blood. HGB (Hemoglobin) measures the amount of oxygen-carrying protein in the blood. HCT (Hematocrit) measures the percentage of red blood cells in the total blood volume. These parameters are important in determining the severity of anemia as they provide information about the quantity and quality of red blood cells and their ability to carry oxygen.
8.
Which element(s) is (are) not detectable in healthy urine:
Correct Answer
D. Glucose and proteins
Explanation
Glucose and proteins are not detectable in healthy urine. Glucose is normally reabsorbed by the kidneys, so it should not be present in urine. Proteins are also typically filtered out by the kidneys and should not be present in significant amounts in urine. The presence of glucose or proteins in urine can indicate underlying health conditions such as diabetes or kidney disease. Therefore, their absence in healthy urine is expected.
9.
Which of the following laboratory findings suggest diabetes:
Correct Answer
D. Fasting plasma glucose (FGP) > 126 mg/dl. measured 2 times
Explanation
A fasting plasma glucose (FPG) level greater than 126 mg/dl measured on two separate occasions is indicative of diabetes. This is because a fasting glucose level above this threshold indicates impaired insulin production or utilization, which is a defining characteristic of diabetes. Therefore, this laboratory finding suggests the presence of diabetes.
10.
Which of the following lab findings exclude iron deficiency anemia?
Correct Answer
C. Low TIBC
Explanation
Low TIBC (Total Iron Binding Capacity) is a lab finding that excludes iron deficiency anemia. TIBC measures the amount of transferrin, a protein that carries iron in the blood. In iron deficiency anemia, the body tries to increase its iron absorption, leading to an increase in TIBC. Therefore, a low TIBC suggests that the body is not trying to increase iron absorption and is not indicative of iron deficiency anemia.
11.
Which of the following parameters is a cardiovascular risk factor:
Correct Answer
A. High homocysteine level
Explanation
High homocysteine level is a cardiovascular risk factor because elevated levels of homocysteine in the blood have been associated with an increased risk of developing cardiovascular diseases such as heart attack, stroke, and peripheral vascular disease. Homocysteine is an amino acid that is normally broken down and cleared from the body, but when its levels are high, it can cause damage to the lining of blood vessels, promote blood clot formation, and contribute to the development of atherosclerosis. Therefore, monitoring and managing homocysteine levels is important in assessing and reducing cardiovascular risk.
12.
Which of the following suggests acute pancreatitis?
Correct Answer
C. High activity of lipase and amylase
Explanation
High activity of lipase and amylase suggests acute pancreatitis. Lipase and amylase are enzymes that are normally found in the pancreas. When the pancreas is inflamed or damaged, such as in acute pancreatitis, these enzymes are released into the bloodstream in higher than normal amounts. Therefore, measuring the activity of lipase and amylase can help in diagnosing acute pancreatitis. The other options listed do not specifically indicate acute pancreatitis.
13.
Choose the tumor marker that is used to diagnose and monitor treatment of primary liver cancer?
Correct Answer
C. AFP
Explanation
AFP, or alpha-fetoprotein, is a tumor marker that is commonly used to diagnose and monitor treatment of primary liver cancer. Elevated levels of AFP in the blood can indicate the presence of liver cancer, and monitoring AFP levels can help track the effectiveness of treatment. Other tumor markers listed in the options, such as CA-125, CEA, CA 19-9, and PSA, are associated with different types of cancer and are not specifically used for primary liver cancer.
14.
A basic marker and prognostic factor for sepsis is:
Correct Answer
D. PCT
Explanation
Procalcitonin (PCT) is a basic marker and prognostic factor for sepsis. PCT levels increase significantly during bacterial infections and sepsis, making it a useful tool for diagnosing and monitoring the severity of sepsis. Elevated PCT levels indicate a higher risk of sepsis and can help guide treatment decisions. Other markers like CRP, WBC, D-dimer, and neutrophils may also be elevated in sepsis, but PCT is specifically recognized as a reliable marker for sepsis.
15.
Which of the following is not an acute complications of diabetes mellitus?
Correct Answer
D. Diabetic kidney
Explanation
Diabetic kidney, also known as diabetic nephropathy, is a chronic complication of diabetes mellitus, not an acute complication. It is characterized by damage to the kidneys due to long-term high blood sugar levels. Acute complications of diabetes mellitus include ketotic acidosis, nonketotic hyperglycemic coma, hypoglycemia, and ketotic coma. These conditions can occur suddenly and require immediate medical attention.
16.
Which of the following is converted into urea?
Correct Answer
C. Nitrogen
Explanation
Nitrogen is converted into urea. Urea is a waste product formed in the liver through the breakdown of proteins and amino acids. Nitrogen is an essential component of proteins, and during protein metabolism, excess nitrogen is converted into urea for excretion through urine. This process, known as the urea cycle, helps maintain nitrogen balance in the body. Therefore, nitrogen is the correct answer as it is the precursor for urea synthesis.
17.
Which of the following hematological parameters suggest pancytopenia:
Correct Answer
A. Low WBC and RBC
Explanation
Pancytopenia refers to a condition where there is a decrease in all three types of blood cells: white blood cells (WBC), red blood cells (RBC), and platelets (PLT). The correct answer, "Low WBC and RBC," suggests pancytopenia because it indicates a decrease in both white blood cells and red blood cells. This combination of low WBC and RBC is consistent with the definition of pancytopenia.
18.
Ketunuria without glycosuria is associated with:
Correct Answer
B. Diabetes mellitus
Explanation
Ketunuria without glycosuria is associated with diabetes mellitus. This is because ketunuria refers to the presence of ketones in the urine, which is a sign of the body breaking down fat for energy instead of glucose. In diabetes mellitus, the body is unable to properly regulate blood sugar levels, leading to high levels of glucose in the blood. When glucose is not available for energy, the body starts breaking down fat, resulting in the production of ketones. Therefore, the presence of ketunuria without glycosuria suggests that the individual may have diabetes mellitus.
19.
Which laboratory values correspond suggest a primary metabolic acidosis?
Correct Answer
A. Decrease pH, decrease HCO3-
Explanation
A primary metabolic acidosis is characterized by a decrease in pH and a decrease in HCO3-. This means that the acidity level in the body is increased and there is a decrease in the concentration of bicarbonate ions, which help to regulate the pH. This can occur due to conditions such as diabetic ketoacidosis, renal failure, or severe diarrhea. The other options do not correspond to a primary metabolic acidosis as they either involve respiratory changes (increased or decreased PCO2) or do not involve a decrease in HCO3-.
20.
Which do laboratory findings suggest hypertonic dehydration?
Correct Answer
A. Option 1
21.
Which parameters confirm hemolysis:
Correct Answer
A. High bilirubin, LDH, low haptoglobin
Explanation
High bilirubin, LDH, and low haptoglobin levels confirm hemolysis. Bilirubin is a breakdown product of red blood cells and is typically elevated in hemolysis. LDH is an enzyme found in red blood cells, and its elevation indicates cell damage. Haptoglobin is a protein that binds to free hemoglobin released from damaged red blood cells, so low levels suggest hemolysis. Therefore, the combination of high bilirubin, LDH, and low haptoglobin is indicative of hemolysis.
22.
Which of the following findings indicate infectious mononucleosis:
Correct Answer
C. Atypical lympHocytes
Explanation
Atypical lymphocytes are an indicator of infectious mononucleosis. In this condition, the body produces abnormal lymphocytes in response to the Epstein-Barr virus. These atypical lymphocytes are larger than normal lymphocytes and have irregular shapes. They can be identified through a blood test, and their presence is a characteristic feature of infectious mononucleosis.
23.
In UTI, the urine analysis shows:
Correct Answer
E. High glucose and ketones, low proteins
Explanation
The presence of high glucose and ketones in the urine, along with low proteins, suggests the possibility of uncontrolled diabetes. In diabetes, the body is unable to properly regulate blood sugar levels, leading to high glucose levels in the urine. Ketones are produced when the body breaks down fat for energy instead of using glucose. The low protein levels may indicate kidney damage, which can occur as a complication of diabetes. Overall, these findings are consistent with the diagnosis of uncontrolled diabetes.
24.
Reticulocytes are:
Correct Answer
B. Immature erythrocytes
Explanation
Reticulocytes are immature erythrocytes, or red blood cells. They are produced in the bone marrow and then released into the bloodstream. Reticulocytes contain remnants of ribosomal RNA, which gives them a reticular or "net-like" appearance when stained. As they mature, these remnants are removed and the reticulocytes become fully functional red blood cells, responsible for carrying oxygen throughout the body. The presence of reticulocytes in the blood can indicate increased red blood cell production, such as during anemia or in response to certain medications or conditions.
25.
Which of the following processes causes acute anuria?
Correct Answer
C. Acute kidney failure
Explanation
Acute kidney failure is the process that causes acute anuria. Acute kidney failure refers to a sudden loss of kidney function, resulting in the inability to produce urine. This can occur due to various reasons such as severe dehydration, kidney infection, kidney injury, or certain medications. Acute anuria is a condition where there is a complete absence of urine production, which is a characteristic symptom of acute kidney failure. Therefore, acute kidney failure is the correct answer for the given question.
26.
Test ROMA is a useful risk factor of:
Correct Answer
D. Ovarian cancer
Explanation
The test ROMA is a useful risk factor for ovarian cancer. This means that the results of the ROMA test can help determine the likelihood of developing ovarian cancer. It is not a risk factor for breast cancer, lung cancer, colorectal cancer, or pancreatic cancer.
27.
Urobilinogen urine level is high in:
Correct Answer
C. Hemolytic anemia
Explanation
The correct answer is hemolytic anemia. Hemolytic anemia is a condition characterized by the breakdown of red blood cells, leading to the release of urobilinogen into the bloodstream. This excess urobilinogen is then filtered by the kidneys and excreted in the urine, resulting in a high urobilinogen urine level. Cholestasis, pancreatic cancer, gallstones in the pancreas, and biliary tract obstacles do not directly cause the breakdown of red blood cells, therefore they would not be expected to result in a high urobilinogen urine level.
28.
What is the normal range for fasting glucose:
Correct Answer
C. 70-100 mg/dl
Explanation
The normal range for fasting glucose is 70-100 mg/dl. Fasting glucose refers to the blood sugar level after not eating or drinking anything except water for at least 8 hours. This range is considered normal because it indicates that the body is able to maintain stable blood sugar levels without any signs of diabetes or other metabolic disorders. Glucose levels below 70 mg/dl may indicate hypoglycemia, while levels above 100 mg/dl may suggest prediabetes or diabetes.
29.
A decrease in neutrophils in the peripheral blood can be referred to as:
Correct Answer
A. Neutropenia
Explanation
Neutropenia refers to a decrease in the number of neutrophils in the peripheral blood. Neutrophils are a type of white blood cell that play a crucial role in fighting off infections. When there is a decrease in neutrophils, the body becomes more susceptible to infections. A shift to the left, on the other hand, refers to an increase in the number of immature neutrophils, indicating an inflammatory response. Agranulocytosis is a severe form of neutropenia where there is a near-complete absence of neutrophils. Neutrophilia, on the other hand, refers to an increase in the number of neutrophils, which can be a sign of infection or inflammation.
30.
Which laboratory test is the most important for patients with anuria?
Correct Answer
C. Kalium iron in serum
Explanation
The correct answer is creatinine in serum. Anuria refers to the absence of urine production, which can be caused by various factors including kidney dysfunction. Creatinine is a waste product that is filtered out of the blood by the kidneys and excreted in urine. Therefore, measuring creatinine levels in the blood can provide important information about kidney function. High levels of creatinine in the serum indicate impaired kidney function, which is crucial to assess in patients with anuria. Urea level in serum and sodium ion in urine may also provide some information about kidney function, but creatinine is considered the most important laboratory test in this context. The option "kalium iron in serum" is not relevant to the assessment of kidney function and can be ruled out.
31.
Elevation of the monocyte percentage above 19% is termed:
Correct Answer
B. Absolute monocytosis
Explanation
Absolute monocytosis refers to an increase in the absolute number of monocytes in the blood. Monocytes are a type of white blood cell that plays a role in the immune response. An elevation of the monocyte percentage above 19% indicates an increase in the number of monocytes, which can be caused by various conditions such as infections, inflammatory disorders, and certain types of cancer. This term specifically focuses on the increase in monocytes rather than other types of white blood cells.
32.
Renal failure with uremia is associated with each of the following except:
Correct Answer
D. Reduced erythropoietin manufacture
Explanation
Renal failure with uremia is associated with various complications, including fibrinous pericarditis, hypercalcemia, and acute interstitial pneumonitis. However, reduced erythropoietin manufacture is not directly associated with renal failure and uremia. Erythropoietin is a hormone produced by the kidneys that stimulates the production of red blood cells in the bone marrow. In renal failure, the kidneys are unable to produce sufficient erythropoietin, leading to anemia. Therefore, the correct answer is reduced erythropoietin manufacture.
33.
Nephrosis is characterized by all symptoms except one:
Correct Answer
D. Hypoproteinemia and hypoalbuminemia
Explanation
Nephrosis is a condition that is characterized by various symptoms. These symptoms include hypergamma globulinemia, hypoimmunity, and proteinuria more than 3.5 g/24 hours. However, hypoproteinemia and hypoalbuminemia are not typically associated with nephrosis. These conditions involve low levels of proteins in the blood, specifically low levels of albumin. In nephrosis, the kidneys are unable to properly filter proteins, leading to increased levels of proteinuria. Therefore, the absence of hypoproteinemia and hypoalbuminemia is the correct answer as these symptoms are not typically seen in nephrosis.
34.
Laboratory determination of HCV include:
Correct Answer
E. All of them
Explanation
The correct answer is "All of them" because laboratory determination of HCV (Hepatitis C Virus) involves multiple tests. ALT (Alanine Aminotransferase) is measured to assess liver function, Anti-HCV antibodies are detected to confirm HCV infection, HCV RNA is measured to determine the viral load, and liver biopsy is performed to assess the extent of liver damage. Therefore, all of these tests are necessary for a comprehensive evaluation of HCV infection.
35.
As the first serological marker of type B infection detected is?
Correct Answer
A. HBsAg
Explanation
HBsAg stands for Hepatitis B surface antigen. It is the first serological marker of type B infection that is detected. This antigen is present on the surface of the hepatitis B virus and can be detected in the blood of infected individuals. Therefore, the presence of HBsAg indicates an active infection with the hepatitis B virus.
36.
Indications of hepatitis B include:
Correct Answer
C. Both A and B
Explanation
The correct answer is both A and B. Indications of hepatitis B include an increase in aminotransferases activity in serum and an increase in bilirubin level in serum. Both of these markers are commonly used to diagnose and monitor liver function, and their elevation is indicative of liver damage or dysfunction, which can occur in hepatitis B infection.
37.
The level of brain natriuretic peptide (BNP) is increasing in the following conditions
Correct Answer
F. B and D
Explanation
The correct answer is B and D. Brain natriuretic peptide (BNP) is a hormone released by the heart in response to increased stretching of the ventricles. In conditions such as pulmonary edema and cardiac arrest, there is increased pressure and stretching of the heart, leading to an increase in BNP levels. However, in conditions like DM (diabetes mellitus) and asthmatic attack, there is no direct effect on the heart's stretching or pressure, so BNP levels would not be expected to increase.
38.
Which of the following test should be done in patients with acute myocardial infarction?
Correct Answer
E. A, B, and C
Explanation
Patients with acute myocardial infarction should undergo ECG, Troponin, and CK-MB tests. ECG (electrocardiogram) is a non-invasive test that measures the electrical activity of the heart and can help diagnose a heart attack. Troponin is a protein released into the bloodstream when heart muscle is damaged, and elevated levels of troponin can indicate a heart attack. CK-MB (creatine kinase-MB) is an enzyme that is released into the bloodstream when there is damage to the heart muscle, and elevated levels of CK-MB can also indicate a heart attack. Therefore, conducting all three tests can provide a comprehensive evaluation of a patient with acute myocardial infarction.
39.
Lipoprotein (a) is similar in structure to:
Correct Answer
D. HDL
Explanation
Lipoprotein (a) is similar in structure to HDL. HDL, or high-density lipoprotein, is a type of lipoprotein that helps remove excess cholesterol from the bloodstream and carries it back to the liver for processing. Lipoprotein (a) is also a type of lipoprotein, but it contains an additional protein called apolipoprotein(a). While both lipoprotein (a) and HDL are involved in cholesterol metabolism, lipoprotein (a) has been associated with an increased risk of cardiovascular diseases, whereas HDL is considered beneficial for heart health.
40.
Which of the following parameters will change in patients not fasting?
Correct Answer
D. All of them
Explanation
In patients not fasting, all of the mentioned parameters - triglycerides, LDL-ch, and HDL-ch - will change. Fasting is required to obtain accurate measurements of these parameters as it helps to eliminate the influence of recent food intake. When a person is not fasting, the levels of triglycerides, LDL-ch, and HDL-ch can be affected by the digestion and absorption of food, leading to fluctuations in their values. Therefore, all of these parameters will show changes in patients who are not fasting.
41.
Cheilosis is defined as:
Correct Answer
B. Disorder of the lips, fissures around the corner of mouth
Explanation
Cheilosis is a disorder characterized by the presence of fissures or cracks around the corners of the mouth. This condition can cause discomfort and pain, especially when opening the mouth or eating. It is often associated with a deficiency in certain vitamins, such as riboflavin (vitamin B2) or iron. The symptoms of cheilosis can vary in severity, ranging from mild dryness and redness to more severe cracking and inflammation. Proper diagnosis and treatment of the underlying nutrient deficiency are important in managing and resolving this condition.
42.
Koilconychia is:
Correct Answer
C. Club-shaped nails
Explanation
Koilonychia is a condition characterized by club-shaped nails. This means that the nails become abnormally thin and spoon-shaped, with a concave shape. This condition is often associated with iron deficiency anemia and can also be caused by other factors such as trauma or certain medical conditions. The nails may appear pale, brittle, and have a tendency to crack or split easily. Treatment involves addressing the underlying cause and may include iron supplementation and proper nail care.
43.
Glossitis can be seen in:
Correct Answer
A. IDA (iron deficiency Anemia)
Explanation
Glossitis, which refers to inflammation of the tongue, can be seen in iron deficiency anemia (IDA). Iron deficiency affects the production of red blood cells, leading to a decrease in oxygen supply to the tissues, including the tongue. This can result in a swollen, smooth, and shiny appearance of the tongue, which is characteristic of glossitis. Cholestasis, diabetes mellitus, and hemolytic anemia, on the other hand, do not typically cause glossitis.
44.
All are indicators of Hemolytic anemia except:
Correct Answer
D. Increased cobalamin
Explanation
Increased cobalamin is not an indicator of hemolytic anemia. Cobalamin, also known as vitamin B12, is involved in the production of red blood cells but its levels do not directly indicate hemolytic anemia. Hemolytic anemia is characterized by the destruction of red blood cells, resulting in elevated lactate dehydrogenase levels, unbound bilirubin, and a decrease in protein haptoglobin.
45.
What is the most common intrinsic cause of hemolytic anemia?
Correct Answer
C. Hereditary spHerocytosis
Explanation
Hereditary spherocytosis is the most common intrinsic cause of hemolytic anemia. This is a genetic disorder characterized by the presence of spherocytes, which are abnormally shaped red blood cells that are more prone to premature destruction. The condition is caused by defects in proteins that are involved in maintaining the shape and stability of red blood cells, leading to their increased fragility and hemolysis. This results in a decrease in the lifespan of red blood cells and subsequent anemia.
46.
A low Reticulocyte count can be due to:
Correct Answer
A. B(12) deficiency
Explanation
A low reticulocyte count can be due to B(12) deficiency. Vitamin B(12) is essential for the production of red blood cells in the bone marrow. Without enough B(12), the bone marrow may not be able to produce an adequate number of reticulocytes, which are immature red blood cells. This can lead to a low reticulocyte count. Bleeding and hemolysis, the destruction of red blood cells, are not directly related to B(12) deficiency and would not typically cause a low reticulocyte count.
47.
In Aplastic anemia the body makes too few of which type of cells?
Correct Answer
D. All the above
Explanation
In aplastic anemia, the body fails to produce enough red blood cells (RBCs), white blood cells (WBCs), and platelets. This condition is characterized by a decrease in the production of all three types of cells. As a result, individuals with aplastic anemia may experience symptoms such as fatigue, increased susceptibility to infections, and abnormal bleeding due to the low levels of RBCs, WBCs, and platelets in their bloodstream.
48.
In Cobalamin deficiency Anemia:
Correct Answer(s)
B. Macrocytic anemia ( > 100 fL)
C. Decreased cobalamin
F. Increased homocysteine
Explanation
In Cobalamin deficiency anemia, the correct answer is macrocytic anemia (>100 fL). This is because cobalamin deficiency leads to impaired DNA synthesis, resulting in the production of larger than normal red blood cells. The decreased cobalamin levels are due to a deficiency in vitamin B12, which is necessary for the normal functioning of red blood cells. Additionally, cobalamin deficiency can cause an increase in homocysteine levels, leading to increased homocysteine.
49.
Pernicious Anemia is:
Correct Answer
C. Megalobastic anemia which results from a lack of intrinsic factor in GI secretions needed for B12 absorption
Explanation
Pernicious anemia is a type of megaloblastic anemia that occurs due to a deficiency of intrinsic factor in GI secretions, which is necessary for the absorption of vitamin B12. This leads to impaired B12 absorption and subsequent deficiency, causing the characteristic large, immature red blood cells (megaloblasts) to form in the bone marrow. It is not a microcytic anemia because the red blood cells produced are actually larger than normal.