Which finding is consistent with pernicious anemia?

Appeared in: HPSSC - 2015

Explanation

A 'beefy red tongue,' also known as atrophic glossitis, is a hallmark sign of pernicious anemia.
This condition results from vitamin B12 deficiency, which causes atrophy of the papillae on the tongue, giving it a smooth, shiny, and reddened appearance.
Pernicious anemia is a type of macrocytic (megaloblastic) anemia where red blood cells are larger than normal (MCV greater than 100 fL).

Option B: This describes a swollen, bumpy tongue with red, inflamed papillae, resembling a strawberry. It is not a sign of pernicious anemia.
Option C: This refers to profuse, watery stools containing flecks of mucus, characteristic of a severe gastrointestinal infection, not an anemia.
Option D: Hypochromic (pale) and microcytic (small) red blood cells are characteristic of iron deficiency anemia, not pernicious anemia.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical manifestations of pernicious anemia as background academic context rather than a clinical decision trigger.
Recognizing atrophic glossitis is a key assessment finding that can prompt a nurse to suspect a nutritional deficiency like B12, leading to earlier diagnosis and treatment.
Patients diagnosed with pernicious anemia require lifelong vitamin B12 supplementation (usually via injection) because their body cannot absorb it from food. Patient education on this is critical for adherence and preventing complications.
What if? If a patient presents with a beefy red tongue but also has a history of chronic alcoholism or is a strict vegan, the cause might be dietary B12 deficiency rather than autoimmune pernicious anemia. The treatment would still be B12 replacement, but the underlying cause is different and may not require lifelong injections if oral supplementation is effective and the diet is corrected.

How to Approach the Question

First, identify the core condition in the question: 'pernicious anemia'.
Second, recall the key pathophysiology and clinical manifestations associated with this specific type of anemia. Remember it's a vitamin B12 deficiency leading to macrocytic anemia and neurological symptoms.
Third, evaluate each option. Does 'beefy red tongue' fit with B12 deficiency? Yes, it's a classic sign (atrophic glossitis).
Fourth, systematically rule out the other options by linking them to their correct associated conditions: Strawberry tongue (scarlet fever), Rice water stool (cholera), and Hypochromic RBCs (iron deficiency anemia).

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 132-134

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 656-658

Practise the full HPSSC - 2015

Attempt every question from this paper in a timed mock, then review the full solution for each one.