Small bowel: short bowel and ileal resection: 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 · Small bowel: short bowel and ileal resection

Sample item

A 40-year-old man had 120 cm of terminal ileum resected for Crohn disease. Two years later he has macrocytic anaemia, paraesthesia and watery diarrhoea that improves with cholestyramine. Which deficiency explains the anaemia?

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

The answer and the reasoning

C. Vitamin B12

Vitamin B12 bound to intrinsic factor is absorbed by specific receptors in the terminal ileum, so resection of more than about 60 cm of terminal ileum causes deficiency, leading to megaloblastic anaemia and neuropathy. Bile salts are also absorbed there, so their loss causes choleraic diarrhoea that responds to bile acid sequestrants. Long-term parenteral B12 is needed.

Option by option

  • A. Folic acid

    Folate is absorbed mainly in the proximal jejunum, which is preserved.

  • B. Iron

    Iron is absorbed in the duodenum and proximal jejunum and would give microcytic anaemia.

  • C. Vitamin B12 (correct)

    The terminal ileum is the exclusive site of B12-intrinsic factor absorption.

  • D. Vitamin C

    Vitamin C deficiency causes scurvy with bleeding, not macrocytic anaemia and 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.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Vitamin B12. Vitamin B12 bound to intrinsic factor is absorbed by specific receptors in the terminal ileum, so resection of more than about 60 cm of terminal ileum causes deficiency, leading to megaloblastic anaemia and neuropathy.

Why is "Folic acid" not the answer?

Folate is absorbed mainly in the proximal jejunum, which is preserved.

Why is "Iron" not the answer?

Iron is absorbed in the duodenum and proximal jejunum and would give microcytic anaemia.

Why is "Vitamin C" not the answer?

Vitamin C deficiency causes scurvy with bleeding, not macrocytic anaemia and neuropathy.

What concept does this question test?

It tests Small bowel: short bowel and ileal resection in General Surgery. Bile salts are also absorbed there, so their loss causes choleraic diarrhoea that responds to bile acid sequestrants. Long-term parenteral B12 is needed.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Small bowel: short bowel and ileal resection?

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.