Southern Medical Journal:
Continued Medical Education
Answers can be found on page 1070
Vitamin Deficiency after Gastric Bypass Surgery
1. Glucose infusion should always be given prior to thiamine supplementation in order to prevent Wernicke encephalopathy.
2. A 38-year-old female who underwent gastric bypass surgery is found on routine laboratory examination to have macrocytic anemia. She has been taking her multivitamins daily. Her hemoglobin level is slightly reduced at 11.1 g/dL and her hematocrit is low at 34.5%. Mean corpuscular volume is increased at 101 fL. Vitamin deficiency is suspected, and after additional laboratory tests, the patient is found to have a decreased folate level at 2.0 ng/mL. After six weeks of supplementation with an additional 1 mg of oral folate daily, the patient returns to clinic. Repeat labs show that her hemoglobin and hematocrit are now within normal limits and her mean corpuscular volume has decreased to 93 fL. Folate levels have increased to 7.3 ng/mL (within normal range). The patient complains of numbness and tingling in her lower extremities bilaterally. What should you do next?
A. Order a nerve conduction study
B. Check B12 levels
C. Increase the dose of folate
D. Order an MRI of the spine
3. What percentage of gastric bypass patients taking multivitamins will require additional supplementation with specific vitamins?
Carcinoid Tumors of the Gastrointestinal Tract
4. Which of the following statements regarding small intestinal obstruction in patients with carcinoid tumor is true?
A. The bulk of the tumor causes extrinsic compression to cause obstruction
B. Intraluminal growth of the tumor in polypoid fashion leads to intussusception of the small intestine causing obstruction
C. Involvement of regional lymph nodes and compression of vasculature is implicated in the etiology of small intestinal obstruction in patients with a carcinoid tumor
D. Intense desmoplastic reaction due to serotonin and other mediators of inflammation leads to mesenteric fibrosis
5. Which of the following computed tomography findings suggests metastatic carcinoid tumor in the liver?
A. Early phase enhancement in the arterial phase of the contrast
B. Enhancement during the portal venous phase
C. Enhancement during the delayed hepatobiliary phase
D. Enhancement during both the arterial and portal venous phases
6. Which of the following is true for somatostatin analogue therapy?
A. Treatment with somatostatin analogues results in significant tumor shrinkage
B. Somatostatin analogues improve symptoms and quality of life with minimal adverse events
C. Long-acting preparation of somatostatin analogues is associated with significant adverse events
D. Somatostatin analogues are not useful for effective control of symptoms of carcinoid syndrome