Glossary of Pathology exam 1-2

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A hydropic change (swelling) is reversible/irreversible
Plasma membrane rupturing and nuclear changes are reversible/irreversible
Condensation of chromatin. Pyknosis, Karyolysis, or Karyorrhexis
Lysis of chromatin. Pyknosis, Karyolysis, or Karyorrhexis
Fragmentation of nuclear material. Pyknosis, Karyolysis, or Karyorrhexis
________ Necrosis the most common type, outline of tissue preserved (MI, kidney infarcts)
________ Necrosis - brain infarcts, abscess, wet gangrene
________ Necrosis - Granulomas of TB/deep fungal
________ Necrosis - found w/ acute pancreatitis or trauma to fat
________ Necrosis - Small vessels; Systemic Lupus
Programmed cell , involves gene activation & enzyme action. NO significant inflammation
Results from cell injury or chronic stress. Is reversible.
Increase in tissue/oragn size due to increase in cell size (Hypertrophy, Hyperplasia, Metaplasia, Atrophy, or Dysplasia)
Increase in tissue/organ size due to increase in number of cells (Hypertrophy, Hyperplasia, Metaplasia, Atrophy, or Dysplasia)
replacement of one mature cell type by another - Barrett's esophagus - reversible in most cases (Hypertrophy, Hyperplasia, Metaplasia, Atrophy, or Dysplasia)
Decrease in tissue/organ size because of a reduction in the size or number of cells. (Hypertrophy, Hyperplasia, Metaplasia, Atrophy, or Dysplasia)
Abnormal cells that are not cancer. (Hypertrophy, Hyperplasia, Metaplasia, Atrophy, or Dysplasia)
Mediated by neutophils, hemodynamic changes, increased permeability of vessel walls, & emigration of leukocytes from vessels into tissues
Acute inflammation
Clear, protein poor, relatively acellular liquid - seen in renal and heart failure (low protein; spec. gravity < 1.02)
Viscous, protein rich, seen in pus (high protein; spec. gravity > 1.02)
Severe generalized swelling of all subcutaneous tissues (cirrhosis or nephrotic syndrome)
Edema in peritoneal cavity (end stage liver disease)
List in order the main events of PMNs crossin out of a vessel (adhesion, margination, transmigration, rolling)
1) Margination, 2) Rolling, 3) Adhesion, 4) Transmigration
Which mediator of inflammation is NOT plasma derived: Nitric Acid, clotting factors, anticoagulants, compliment protiens, kinins
Nitric Acid
Which mediator of inflammation is NOT cell derived: Biogenic Amines, Arachidonic acid & derivatives, Cytokines, Kinins, Platlet activating factors, Nitric Acid
Hageman, thrombin & fibrinogen are ___________ (clotting factors, anticoagulants, compliment protiens, kinins)
clotting factors
Plasmin is ________: (clotting factors, anticoagulants, compliment protiens, kinins)
Bradykinin is ________: (clotting factors, anticoagulants, compliment protiens, kinins)
Histamine & seratonin are ___________ (released from mast cells & platlets): (Biogenic Amines, Arachidonic acid & derivatives, Cytokines, Platlet activating factors, Nitric Acid)
Biogenic Amines
Prostaglandins & leukotrienes are derivatives of ________: (Biogenic Amines, Arachidonic acid, Cytokines, Platlet activating factors, Nitric Acid)
Arachidonic acid
________ is produced from endothelial cells & macrophages: (Biogenic Amines, Arachidonic acid, Cytokines, Platlet activating factors, Nitric Acid)
Nitric Acid
2 Mediators that cause vasodialation. (prostaglandins, histamine, bradykinin, platlet activating factor, NO, leukotrines)
prostaglandins, NO
4 Mediators causing increased vascular permeability. (prostaglandins, histamine, bradykinin, platlet activating factor, interleukins, leukotrines)
histamine, bradykinin, platlet activating factor, leukotrines
3 Mediators involved w/ chemotaxis. (C5a, C3b leukotriene B4, interleukins)
C5a, leukotriene B4, interleukins (C3b - tags the cells for phagocytosis)
2 Mediators causing pain. (prostaglandins, histamine, bradykinin)
prostaglandins, bradykinin
3 Mediators involved w/ phagocytosis (Neutrophils, plasma cells, eosinophils, macrophages)
Neutrophils, eosinophils, macrophages
The 2 different activation pathways of compliment
Classical pathway (Ant-Ab), Alternative (fragment of fungi, bact, toxins, foreign substances)
4 functions of compliment activiation. (opsonization of bacteria, anaphylatoxic action, chemotaxis, increase in hypertension, cytolysis)
opsonization of bacteria, anaphylatoxic action, chemotaxis, cytolysis
Coating w/ IgG & C3b is what function of compliment? (opsonization of bacteria, anaphylatoxic action, chemotaxis, cytolysis)
opsonization of bacteria
Stimulating release of histamine is what funciton of compliment? (opsonization of bacteria, anaphylatoxic action, chemotaxis, cytolysis)
anaphylatoxic action
C5a attracts neutrophils is what function of compliment? (opsonization of bacteria, anaphylatoxic action, chemotaxis, cytolysis)
MAC complex relates to what function of compliment? (opsonization of bacteria, anaphylatoxic action, chemotaxis, cytolysis)
List the primary healing sequence in order (restructuring, scarring, bleeding & clot formation, inflammation, granulation tissue)
1) bleeding & clot formation, 2) inflammation, 3) granulation tissue, 4) scarring, 5) restructuring
Hypertrophic scar composed of type 3 collagen (result from defective remodeling of scar tissue.
what cell type cannot regenerate -i.e. neurons, striated muscle, myocardium? (Permanent, Labile, Stable)
what cell type can readily regenerate -i.e. skin, mucosa? (Permanent, Labile, Stable)
what cell type can also regenerate -i.e. liver or kidney? (Permanent, Labile, Stable)
Which is not a main cause of edema? (Increased intravascular/hydorstatic pressure, increased permiability of vessel wall, increased oncotic pressure/increased albumin, decreased oncotic pressure/reduced albumin, sodium retention, obstruction of lymph flo
increased oncotic pressure/increased albumin
reduced perfusion of kidneys (i.e. heart failure) --> renin secretion --> inc _______ from adrenal cortex --> kidney retains more ____ --> water retention --> inc hydrostatic pressure & edema.
aldosterone, sodium
Active process, influx into tissues, bright red & warm (Congestion or Hyperemia)?
Passive process-stasis, tissue is dusky red to blue, tissues are cold & clammy (Congestion or Hyperemia)?
______ _____: chronic passive congestion results in pooling & necrosis of hepatocytes. (red-brown) These hepatocytes are replaced by fibrous tissue - uncongested areas appear pale tan
Nutmeg liver
The 3 main components of Hemostasis are: (compliment, vascular wall, platlets, coagulation cascade)
Primary hemostasis involves which 3: (platelet adhesion & shape change, secretion of granules by platelets, recruitment & aggregation to form hemostatic plug, activation of the coagulation cascade)
platelet adhesion & shape change, secretion of granules by platelets, recruitment & aggregation to form hemostatic plug (activation of the coagulation cascade is involved in secondary hemostasis)
Mediator of platelet adhesion to subendothelial collagen in primary hemostasis
Secondary hemostasis involves the activation of the coagulation cascade (T/F)
Virchow's triad are factors predisposing to heart failure (T/F)
FALSE they are predisposing to thrombosis
Which one does NOT belong in Virchow's triad? Endothelial injury, Alteration of flow (stasis or turbulance), Hypocoagulability, Hypercoagulability
Which is NOT a fate of a thrombus? Resolution, Translocation, Propagation & eventual occlusion, Organization, Recanalization, Embolization
Venous emboli originates in the deep leg veins and goes to the _____
_____ usually arise in the deep veins of the leg, often multiple, may cause pulmonary hypertension/right sided heart failure over time
Pulmonary (I think this is the same as a venous emboli)
______ emboli originate in areas of high BP (heart, aorta, or large arteries) and go to various organs (most to lower extremities, 10% to brain)
laminated appearance that is characteristic of thrombi
lines of Zahn
____ emboli occur w/ fracture of long bones
left sided emboli originating in venous circulation, but gains access to arterial circulation through patent foramen ovale or atrial-septal defect
Paradoxical emboli
Infarct w/ atrial occlusions to solid organs (heart, liver, spleen), wedge shaped w/ occluded vessel at apex.
Pale infarct
Infarct in loose tissues (lung) or tissues w/ dual circulation
Red infarct
Clotting disorder - Microthrombi in small vessels consume platelets & deplete fibrin. Can be triggered by obstetric complication, shock, gram neg sepsis, extensive trauma
DIC (disseminated intravascular coagulation)
Hypoperfusion of body tissues w/
Shock due to pump failure. (Cardiogenic, Hypovolemic, Hypotensive)
Shock due to wounds, burns, vomiting. (Cardiogenic, Hypovolemic, Hypotensive)
Shock due to peripheral vasodialtion - bacterial toxins, anaphylactic, neural injury. (Cardiogenic, Hypovolemic, Hypotensive)
Which is not a lipid storage disease? Tay Sachs, Phenylketonuria, Gaucher's, Neimann Pick, Fabry's
Which lipid storage disease results from a deficiency of hexosaminidase A? Tay Sachs, Gaucher's, Neimann Pick, Fabry's
Tay Sachs
Which lipid storage disease results from a deficiency of beta glucosidase? Tay Sachs, Gaucher's, Neimann Pick, Fabry's
Which lipid storage disease results from a deficiency of sphingomyelinase? Tay Sachs, Gaucher's, Neimann Pick, Fabry's
Neimann Pick
Which lipid storage disease results from a deficiency of alpha galactosidase? Tay Sachs, Gaucher's, Neimann Pick, Fabry's
A type of mucopolysaccharidoses, a deficiency of alpha-L-iduronidase - results in buildup of heparin sulfate & dermatan sulfate
Hurler's syndrome
Abnormality in AA metabolism, deficiency of phenylalanine deaminase --> blocks conversion of phe to tyr. Can lead to mental & neurologic deterioration.
Phenylketonuria (PKU)
Intercelluar deposition of a proteinaceous material in beta-pleated sheets; many different amyloid proteins. If deposited in sufficient amounts it can interfere w/ cell functions - i.e. heart, adrenal, liver, & kidney (deposits in the glomeruli-nephr
Homogenous pink material on H&E sections; green bifringence when stained w/ Congo red & subjected to polarized light.
Amyloidosis is seen in all except one: multiple myeloma, medullary carcinoma of the thyroid, Alzheimer's disease, systemic lupus
systemic lupus
Amyloidosis is curable (T/F)
cancer-inducing genes
normal genes that can become oncogenes
abnormal cell growth
Epstein Barr virus is associated with all except: Nasopharyngeal carcinoma, Burkitt's lymphoma, Infectious mononucleosis, Oral hairy leukoplakia, Cervical carcinoma
Cervical carcinoma
HPV (human papilloma virus) subtypes 16, 18, 33 is associated w/ ______ _____
cervical cancer
HPV (human papilloma virus) subtypes 6 & 11 is associated w/ ______ _____ such as condyloma accuminatum (genital wart)
benign lesions
The most frequent caner in men
The most frequent caner in women
The most frequent cause of cancer in both men & women
Lung cancer
______ is the second most common cause of in the US, following ________ _________
Cancer, cardiovascular disease
_________ is the single most important defining characteristic of malignancy
The 3 routes of metastasis are: hematogenous, transplant, lymphatic, direct seeding of body cavities
hematogenous, lymphatic, direct seeding of body cavities
The 2 best known tumor suppressor genes are ___ & ___. Loss or mutation of these genes can lead to cancer.
p53, Rb-1 (retinoblastoma)
The tumor suppressor genes WT1 & WT2 are associated with: Wilms tumor, familial polyposis coli, or breast cancer
Wilms tumor
The tumor suppressor gene APC is associated with: Wilms tumor, familial polyposis coli, or breast cancer
familial polyposis coli
The tumor suppressor gene BRCA-1 is associated with: Wilms tumor, familial polyposis coli, or breast cancer
breast cancer
What is the 2 hit hypothesis of Knudsen?
2 mutagenic events are required to initiate alterations of both chromosomes
_________ are associated w/ gene amplification (N-myc oncogene)
2 hereditary cancers
familial polyposis coli, Wilms tumor
The most common autosomal disease in the US - linked to a defective or missing NF1 gene.
Neurofibromatosis Type 1
Most neoplasms are ___________
______ _____ - Right ventricle hypertrophy due to pulmonary hypertension secondary to disorders of the lungs or pulmonry vessels
Cor pulmonale
COPD (Chronic Obstructive Pulmonary Disease), Chronic lung disease (cystic fibrosis, bronchiectasis, interstitial fibrosis), & recurrent thromboemboli can cause _____ ______ (a condition of the hear)
Cor pulmonale
Abrupt onset of right ventricular dilatation due to a massive pulmonary embolism
Acute cor pulmonale
Chronic passive congestion of lungs in left sided heart failure --> intra-alveolar hemorrhage --> RBCs that are forced out of the vessels are taken up by macrophages --> brown hemosiderin granules in macrophages --> called "_____ ____ ce
"heart failure cells"
_____ _____ _____ _____ results in pulmonary edema, Hemosiderin laden macrophages (heart- failure cells) in lungs, Chronic passive congestion in liver (nutmeg liver)
Left sided heart failure
_____ ____ ____ ____ is usually the result of left-sided heart failure, Jugular vein distension, peripheral edema, ascites
Right sided heart failure
The most common congenital heart defect recognized in clinical practice, initially is non-cyanotic w/ left to right shunting of ; in late stages flow is reversed
Ventricular-septal defect
Important cause of cyanosis at birth
Tetralogy of Fallot
Which is NOT part of the Tetrology of Fallot? Ventricular septal defects, Atrial septal defects, Pulmonary artery stenosis, Right ventricular hypertrophy, Dextroposition of the aorta
Atrial septal defects
inflammation of heart muscle
most cases of myocarditis are of _____ origin, can also be of autoimmune origin such as in SLE (lupus)
a multifactorial disease of large and medium sized arteries that is characterized by the accumulation of lipids, fibrosis, and calcification of the arterial walls.
Which is not a risk factor for Atherosclerosis: Advancing age, (males until menopause then equal), Hereditary, Diet rich in lipids, Hypertension, Hypotension
Fatty streaks & intimal thickening, Atheromatous plaques, and Progressive narrowing to complete occlusion of the arterial lumen are pathological changes of __________
Intermittent attacks of chest pain
Type of angina that is exercised induced. Stable, Prinzmetal, Unstable
Type of angina that is at rest, due to coronary vasospasms. Stable, Prinzmetal, Unstable
Type of angina that is at rest and last long. Stable, Prinzmetal, Unstable
Leading cause of in the US, due to occlusion of the coronary arteries by a thrombus at the sight of a ruptured athersclerotic plaque
________ infarcts are the most common type characterized by coagulation necrosis
Match the times w/ events: 6-12hrs / 12-24 hrs / 24-72 hrs / >72hrs / within 6 wks……neutrophils / scarring / pale area / inc creatine kinase, troponin, & myoglobin / neutrophils replaced by macrophages, resorption of necrotic muscle tissue &am
6-12hrs…inc creatine kinase, troponin, & myoglobin / 12-24 hrs...pale area / 24-72 hrs...neutrophils / >72hrs...neutrophils replaced by macrophages, resorption of necrotic muscle tissue & formation of granulation tissue / within 6 wks… scarring
Endocarditis is always the result of an infection (T/F)
FALSE it can be Infective or sterile
Sterile endocarditis - Nonbacterial thrombotic endocarditis is also called _____ ______
Marantic endocarditis
_______ endocarditis characterized by deposition of small sterile ____ thrombi on prevously normal valves
Sterile, fibrin
An example of Sterile Endocarditis
Libman-Sacks endocarditis (SLE)
Abnormal immune response to streptococci (Group A beta hemolytic strep) in children affecting the heart
Rheumatic fever
tiny lumps in the heart muscle typical of Rheumatic heart disease
Aschoff bodies
Rheumatic fever can lead to abnomalities of the heart _____ which are prone to ________ & infections
valves, calcification
Rheumatic fever can result in ______ (Inflammation of the entire heart) and may be present w/ endocarditis, myocarditis, & pericarditis
A developmental disorder that causes growth retardation, facial abnormalities (maxillary hypoplasia etc.), & mental retardation
Fetal alcohol syndrome
Developmental disorder that causes Microcephaly, Microphthalmia, Cardiac defects
Which one is NOT (or does not result in) a develpmental disorder: Fetal alcohol syndrome, Rubella, Herpes, Thalidomide, Radiation exposure
47 XXY, Tall male, infertile, testicular atrophy
45 X Short female, web neck, infertility, streak gonads
Trisomy 21, congenital heart disease, 15X inc risk for leukemia, male infertile, early alzheimer changes in CNS
Down's syndrome
Autosomal nt gene defect, defective fibrillin protein, floppy valve syndrome, dissecting aortic aneurysms, eye disorders (cataracts, detached retina)
Autosomal nt gene defect, "rubber man" - hypermobility & hyperelasticity, defect in collagen gene, fragile vessels
Ehler Danlos
Autosomal nt gene defect, defect in collagen type 1, bones break easily, blue sclerae, dentinogenesis imperfecta
Osteogenesis imperfecta
Autosomal nt gene defect, dwarfism (short limbs), defect in endochondral ossification, affects long bones, mutation of gene encoding the receptor for fibroblast growth factor
Autosomal nt gene defect, gene on chromosome 16, progressive cystic dilation of renal tubules which become non-functional - renal failure in 3rd to 4th decade
Adult polycystic kidney disease
Autosomal nt gene defect, Expanded CAG nucleotide repeat chromosome 4, progressive dementia, chorea (involuntary movements), and affective outbursts
Huntington disease
Autosomal nt gene defect, low density lipoprotein cannot be removed from circulation leading to accelerated atherosclerosis & deposits fo cholesterol in tissues (xanthomas)
Familial hypercholesterolemia
Most common lethal autosomal recessive disorder, almost exclusively caucasians, involves lack of transport of chloride across the cell memebrane; affects bronchial glands (mucous buildup) and pancreas (dilation of ducts w/ thick mucous --> fibrosis),
Cystic Fibrosis
Important test for cystic fibrosis
sweat test (Cl)
Which Lysosomal storage disease in not autosomal recessive: Tay Sachs, Gaucher's, Neimann Pick, Fabry's, Hurlers
fattly stools
Malabsorption syndrome w/ glutin sensitivity, villous atrophy, flat mucosa, chronic inflammation, growth retardation (failure to thrive)
Celiac disease
Malabsorption syndrome, small intestine, tropheryma whippeli bacillus in PAS positive macrophages, arthralgias (joint pain), cardiac, neurologic symptoms
Whipple's disease
dilation of colon (megacolon) & absence of ganglion cells
Hirshprung's disease
Flask shaped ulcers in colon; liver abscesses
Entamoeba histolytica
the most common type of polyp to have malignant transformation, but they are the least common type of polyp
Villous adenomas
Which one is NOT a Multiple polyposis syndrome (very high malignant potential): Entamoeba histolytica, Gardner syndrome, Familial polyposis, Turcot syndrome
Entamoeba histolytica
Which is NOT a predisposing factor for colon cancer? Adenomatous polyps, inherited polyosis syndrome, Huntington disease, longstanding ulcerative colitis, genetic factors, low fiber/high animal fat diet
Huntington disease
Which is not a Type 1 hypersensitivity eczema, hay fever, asthma, anaphylactic shock, contact dermatitis.
contact dermatitis = type 4
Which is not a Type 2 hypersensitivity reaction: Goodpastures, serum sickness, autoimmune hemolytic anemia, transfusion reactions, erythroblastisis fetalis, hypersensitivity, Graves disease, myasthenia graves.
serum sickness = Type 3
Type 3 hypersensitivity reactions include SLE, serum sickness, erythematosus and _________.
polyarteritis nodosa
Contact dermatits, sarcoidosis and TB are Type __ reactions.
Type 4 reactions require antibodies. T/F
IgG is the most abundant Ig. T/F
Which Ig is first to be excreted on antigenic stimulation.
IgE is found on the surface of ____ cells involved with Type 1 reactions.
Congo red dye --> green birefringence of this beta-pleated material.
Primary amyloidosis is associated with monoclonal B cell proliferation; secondary with chronic inflammatory process. T/F
True; True
________ amyloidosis is found in the heart, kidneys, adrenal glands and liver. T/F
Alzheimer's, medullary thyroid carcinoma and Langerhans cells of Type 2 diabetics may demonstrate _______ amyloidosis.
This disease is characterized by C-R-E-S-T, calcinosis, raynauds, esphageal dysmotility, sclerodactly and telangiectasia.
An immune complex vasculitis causing fibrinoid necrosis and thrombi in small to medium arteries more common in men:
polyarteritis nodosa
Chronic inflamatory process involving muscles of extremities more common in women:
Similar to polymyositis but involves skin:
Libman Saks endocarditis, glomerulonephritis, arthritis and anti Smith antibodies:
SLE - also butterfly rash, raynauds
Also referred to as the "pulseless" disease when affecting the aortic arch, this disease causes intermittent claudicationa nd ischemic necrosis when the lower aorta is invloved.
Takayasu's arteritis
Inflamation and thrombi in medium sized vessels of the lower extremities cause cramping:
Buergers disease - young men smokers
_______ causes "skip areas" of nodular thickening of elastic arteries.
giant cell arteritits (temporal arteries)
This autoimmune disease causes necrotizing vasculitis and a triad of lesions; URT, lung and kidney.
Wegener's disease - shows anti-neutrophil antibodies (C-ANCA)
Normal cells - abnormal location:
Normal cells - abnormal arrangement:
3 germ layers, benign/malignant usually ovariy/testes
The extent the tumor spreads is referred to as ____.
Grading refers to _____ features
What is the most reliable sign of malignancy?
Most malignant neoplasms are polyclonal. T/F
False - mono, benign are polyclonal
Which carcinogen is paired incorrectly: asbestos-mesothelioma, aniline dyes-bladder cancer, arsenic-skin/lung, aflatoxin-leukemia.
aflatoxin (aspergillus-mold grain)-liver cancer
Which carcinogen is paired incorrectly: benzene-leukemia, uranium-lung, chimney sweep-scrotal cancer.
all are correct
Which virus is matched incorrectly: EBV-mono/Burkitt's, HPV 16/18-cervical cancer, Hep B/C-hepatocellular carcinoma, Herpes 8-bursitis.
Herpes 8-Kaposi's
Proto-oncogene --> oncogene by 4 mechanisms: point mutation, gene amplification, _________ and _______.
translocation, insertion
_______ is an example of malcontrolled gene amplification.
Philly chromosome --> chronic myelogenous lukemia and EBV --> Burkitt's are examples of _____.
translocation, insertion
HBV --> liver cell is an example of ________.
insertional mutagenesis
Which is not a tumor suppressor gene: p53, APC, NFI, WTI, VHL, BRCA1&2.
all are correct
List the signs & symptoms of congenital infection (TORCH)
Toxoplasma, Others (HIV, syphilis, TB, EBV), Rubella, Cytomegalovirus, Herpes
The 2nd most common inherited cause of mental retardation (after Down's syndrome), Expansion of CGC trinucleotide repeat.
Fragile X syndrome
Fragile X syndrome, Huntingtons, myotonic dystrophy, & Friedreichs ataxia are all gentic defects of what type?
Trinucleotide repeats
Most common autosomal nt disease
Familial hypercholesterolemia
Most common autosomal recessive diseases
sickle cell anemia, thalassemia, hereditary hemochromatosis
Which is NOT a tumor marker: Alphafetalprotein, human chronic gonadotropin (HCG), seritonin, calcintonin, PSA, CEA
occures in children following an acute viral febrile illness in association w/ asprin intake. Characterized by microvesicular fatty changes in the liver & encephalopathy
Reye Syndrome
Match the name w/ the disease: Marasmus, Kwashiorkor…protein deficiency w/ adequate calories > 1yr old (fattly liver, hypoalbumineria --> severe edema), deficiency of almost all nutrients < 1yr old
Marasmus= deficiency of almost all nutrients < 1yr old, Kwashiorkor=protein deficiency w/ adequate calories > 1yr old (fattly liver, hypoalbumineria --> severe edema)
Vitamin ___ deficiency results in pernicious anaemia, neuropsychiatric disorders
Vitamin ___ deficiency results in Pellegra (3 D's: dementia, diarrhea, dermatitis
Vitamin ___ deficiency results in Beriberi, also w/ alcoholics it can lead to Wernicke Korsakoff syndrome --> ataxia (loss of coordination) , confusion, confabulation (stories)
B1 (thiamin)
Vitamin ___ deficiency results in defective collagen (bone formation, bleeding, poor wound healing)
Vitamin ___ deficiency results in Rickets in children & osteomalacia in s
Deficiency of _____ _____ results in magaloblastic anemia (neurological dysfunction)
folic acid

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