Which of the following causes of long-term blood loss may NOT cause noticeable symptoms?

Correct Answer: C

Rationale: The correct answer is C: Intestinal polyps. Intestinal polyps can cause long-term blood loss without noticeable symptoms because the blood loss is gradual and may not be enough to cause visible signs like anemia. Bleeding from the kidneys (A), heavy menstrual bleeding (B), and a ruptured blood vessel (D) are more likely to cause noticeable symptoms such as blood in urine, excessive menstrual bleeding, and sudden severe bleeding, respectively.

Correct Answer: A

Rationale: The correct answer is A because both vitamin B12 and iron can have reduced absorption when taken with drugs that decrease stomach acid like PPIs and H2 blockers. This is due to the acidic environment in the stomach being necessary for the absorption of these nutrients. Therefore, taking them with these medications can lead to deficiencies. Methyldopa, metformin, and antibiotics do not directly interact with vitamin B12 or iron absorption, making them incorrect choices.

Correct Answer: A

Rationale: The correct answer is A: Coombs test. The Coombs test detects antibodies attached to red blood cells, a characteristic of hemolytic anemia. This test helps identify the presence of autoimmune hemolytic anemia. B: Genetic testing is not typically used to detect hemolytic anemia as it focuses on genetic mutations rather than the antibodies causing the condition. C: Peripheral blood smear can show abnormal red blood cell shapes in hemolytic anemia but does not directly detect the presence of antibodies causing the hemolysis. D: Schilling test is used to assess vitamin B12 absorption and is not relevant to detecting hemolytic anemia.

Correct Answer: A

Rationale: The correct answer is A: TRUE. Isozymes of 2C, specifically CYP2C9, play a crucial role in metabolizing warfarin. Variants of CYP2C9 can lead to variations in warfarin metabolism, affecting its efficacy and risk of bleeding. Therefore, isozymes of 2C can significantly impact warfarin therapy. Choice B (FALSE) is incorrect because multiple studies have shown the impact of CYP2C9 isozymes on warfarin metabolism. Choice C (Sometimes) is vague and does not acknowledge the consistent influence of CYP2C9 on warfarin. Choice D (Only in high doses) is incorrect as CYP2C9 variants affect warfarin metabolism irrespective of the dose administered.

Correct Answer: A

Rationale: The correct answer is A: Soccer-ball. In Chronic Lymphocytic Leukemia (CLL), lymphocytes typically appear small or slightly larger than normal, with hypercondensed nuclear chromatin and the presence of bare nuclei called 'smudge cells'. The comparison to a soccer-ball is apt as soccer-balls are relatively small, round, and have a unique pattern on their surface. Choices B, C, and D are incorrect as they do not accurately describe the characteristic appearance of lymphocytes in CLL. B: Basketball is too large and lacks the hypercondensed nuclear chromatin pattern. C: Football is not round and lacks the specific nuclear chromatin pattern. D: Tennis-ball is also too small and does not exhibit the characteristic appearance of CLL lymphocytes.