Upper gastrointestinal surgery: recognition: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Upper gastrointestinal surgery: recognition

Sample item

A patient five years after total gastrectomy has a macrocytic anaemia with peripheral neuropathy. What is the underlying mechanism?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Loss of intrinsic factor leading to vitamin B12 malabsorption

Parietal cells produce intrinsic factor, so total gastrectomy ends B12 absorption and stores deplete over years. Prophylactic parenteral B12 is needed lifelong. Iron deficiency gives microcytic anaemia.

Option by option

  • A. Increased red cell destruction by hypersplenism

    Hypersplenism is not a feature of gastrectomy.

  • B. Loss of gastric acid causing iron malabsorption

    Iron deficiency causes microcytic anaemia without neuropathy.

  • C. Loss of intrinsic factor leading to vitamin B12 malabsorption (correct)

    Correct. Absent intrinsic factor causes macrocytosis with neuropathy.

  • D. Excess folate loss through the bypassed duodenum

    Folate deficiency does not cause neuropathy.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Loss of intrinsic factor leading to vitamin B12 malabsorption. Parietal cells produce intrinsic factor, so total gastrectomy ends B12 absorption and stores deplete over years.

Why is "Increased red cell destruction by hypersplenism" not the answer?

Hypersplenism is not a feature of gastrectomy.

Why is "Loss of gastric acid causing iron malabsorption" not the answer?

Iron deficiency causes microcytic anaemia without neuropathy.

Why is "Excess folate loss through the bypassed duodenum" not the answer?

Folate deficiency does not cause neuropathy.

What concept does this question test?

It tests Upper gastrointestinal surgery: recognition in General Surgery. Prophylactic parenteral B12 is needed lifelong. Iron deficiency gives microcytic anaemia.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Upper gastrointestinal surgery: recognition?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.