Practice questions Anemia IV
Practice questions
Anemia IV
© Jun Wang, MD, PhD
Abbreviations:
|
Hb: hemoglobin |
HCT: hematocrit |
|
MCV: Mean Corpuscular Volume |
MCH: Mean Corpuscular Hemoglobin |
|
RDW: Red Cell Distribution Width |
TIBC: total iron binding capacity |
1. Use this case for the next seven questions. A 45-year-old woman presents to clinic with fatigue, weakness, and shortness of breath on exertion for the past 3 months. She has occasional palpitations and lightheadedness as well. Her menstrual periods have been heavier than usual over the past year. She does not have any significant weight loss, night sweats, or changes in bowel habits. Her past medical history is unremarkable. Physical examination reveals pale skin and conjunctivae and spoon-shaped nails. Her CBC reveals a hemoglobin of 9.0 g/dL (normal: 12-15 g/dL), MCV of70 fL (normal: 80-100 fL), and RDW of 25% (11.5-14.5%). Her WBC and platelet counts are within normal ranges. An image of her peripheral blood smear is shown. What test needs to be done next?
B. Direct antiglobulin test
C. Hemoglobin electrophoresis/HPLC
D. Osmotic fragility test
E. Serum iron tests
2. A 45-year-old woman presents to clinic with fatigue, weakness, and shortness of breath on exertion for the past 3 months. She has occasional palpitations and lightheadedness as well. Her menstrual periods have been heavier than usual over the past year. She does not have any significant weight loss, night sweats, or changes in bowel habits. Her past medical history is unremarkable. Physical examination reveals pale skin and conjunctivae and spoon-shaped nails. Her CBC reveals a hemoglobin of 9.0 g/dL (normal: 12-15 g/dL), MCV of70 fL (normal: 80-100 fL), and RDW of 25% (11.5-14.5%). Her WBC and platelet counts are within normal ranges. An image of her peripheral blood smear is shown.
Her serum iron tests reveal a ferritin of 10 ng/mL (30-400 ng/mL) and iron of 20 µg/dL (60-170 µg/dL). What additional test result is likely elevated?
(Image credit: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
B. Hepcidin
C. Indirect bilirubin
D. Total iron-binding capacity
E. Transferrin saturation
3. A 45-year-old woman presents to clinic with fatigue, weakness, and shortness of breath on exertion for the past 3 months. She has occasional palpitations and lightheadedness as well. Her menstrual periods have been heavier than usual over the past year. She does not have any significant weight loss, night sweats, or changes in bowel habits. Her past medical history is unremarkable. Physical examination reveals pale skin and conjunctivae and spoon-shaped nails. Her CBC reveals a hemoglobin of 9.0 g/dL (normal: 12-15 g/dL), MCV of70 fL (normal: 80-100 fL), and RDW of 25% (11.5-14.5%). Her WBC and platelet counts are within normal ranges. An image of her peripheral blood smear is shown. An image of her peripheral blood smear is shown.
Her serum iron tests reveal a ferritin of 10 ng/mL (30-400 ng/mL) and iron of 20 µg/dL (60-170 µg/dL). What is likely seen in her bone marrow biopsy?
(Image credit: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
B. Hypocellular bone marrow with focal fibrosis
C. Isolated erythroid hyperplasia with nuclear atypia
D. Myeloid precursors with hypersegmented nuclei
E. Scattered macrophages without stainable iron
4. A
45-year-old woman presents to clinic with fatigue, weakness, and shortness of
breath on exertion for the past 3 months. She has occasional palpitations and
lightheadedness as well. Her menstrual periods have been heavier than usual
over the past year. She does not have any significant weight loss, night
sweats, or changes in bowel habits. Her past medical history is unremarkable.
Physical examination reveals pale skin and conjunctivae and spoon-shaped nails.
Her CBC reveals a hemoglobin of 9.0 g/dL (normal: 12-15 g/dL), MCV of70 fL
(normal: 80-100 fL), and RDW of 25% (11.5-14.5%). Her WBC and platelet counts
are within normal ranges. An image of her peripheral blood smear is shown. An
image of her peripheral blood smear is shown.
Her serum iron tests reveal a ferritin of 10 ng/mL (30-400 ng/mL) and iron of 20 µg/dL (60-170 µg/dL). What is the cause of her CBC results?
(Image credit: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
B. Delayed division of hematopoietic precursors
C. Erythroid stem cell defects
D. Red cell membrane instability
E. Reduced heme synthesis
5. A
45-year-old woman presents to clinic with fatigue, weakness, and shortness of
breath on exertion for the past 3 months. She has occasional palpitations and
lightheadedness as well. Her menstrual periods have been heavier than usual
over the past year. She does not have any significant weight loss, night
sweats, or changes in bowel habits. Her past medical history is unremarkable.
Physical examination reveals pale skin and conjunctivae and spoon-shaped nails.
Her CBC reveals a hemoglobin of 9.0 g/dL (normal: 12-15 g/dL), MCV of70 fL
(normal: 80-100 fL), and RDW of 25% (11.5-14.5%). Her WBC and platelet counts
are within normal ranges. An image of her peripheral blood smear is shown. An
image of her peripheral blood smear is shown.
Her serum iron tests reveal a ferritin of 10 ng/mL (30-400 ng/mL) and iron of 20 µg/dL (60-170 µg/dL). What is the cause of her iron study results?
(Image credit: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
B. Celiac disease
C. Chronic bleeding
D. Diet deficiency
E. Medications
6. A
45-year-old woman presents to clinic with fatigue, weakness, and shortness of
breath on exertion for the past 3 months. She has occasional palpitations and
lightheadedness as well. Her menstrual periods have been heavier than usual
over the past year. She does not have any significant weight loss, night
sweats, or changes in bowel habits. Her past medical history is unremarkable.
Physical examination reveals pale skin and conjunctivae and spoon-shaped nails.
Her CBC reveals a hemoglobin of 9.0 g/dL (normal: 12-15 g/dL), MCV of70 fL
(normal: 80-100 fL), and RDW of 25% (11.5-14.5%). Her WBC and platelet counts
are within normal ranges. An image of her peripheral blood smear is shown. An
image of her peripheral blood smear is shown.
Her serum iron tests reveal a ferritin of 10 ng/mL (30-400 ng/mL) and iron of 20 µg/dL (60-170 µg/dL). What is the diagnosis?
(Image credit: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
B. Iron deficiency anemia
C. Lead associated anemia
D. Megaloblastic anemia
E. Sickle cell anemia
7. A
45-year-old woman presents to clinic with fatigue, weakness, and shortness of
breath on exertion for the past 3 months. She has occasional palpitations and
lightheadedness as well. Her menstrual periods have been heavier than usual
over the past year. She does not have any significant weight loss, night
sweats, or changes in bowel habits. Her past medical history is unremarkable.
Physical examination reveals pale skin and conjunctivae and spoon-shaped nails.
Her CBC reveals a hemoglobin of 9.0 g/dL (normal: 12-15 g/dL), MCV of70 fL
(normal: 80-100 fL), and RDW of 25% (11.5-14.5%). Her WBC and platelet counts
are within normal ranges. An image of her peripheral blood smear is shown. An
image of her peripheral blood smear is shown.
Her serum iron tests reveal a ferritin of 10 ng/mL (30-400 ng/mL) and iron of 20 µg/dL (60-170 µg/dL). What should be done next?
(Image credit: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
B. Colonoscopy exam
C. Endometrial biopsy
D. Iron supplementation
E. Vitamin B12 supplementation
8. Use this case for the question. A 71-year-old man presents to the clinic with fatigue for 3 months. His past medical history is unremarkable. Physical examination reveals pale skin and mucosa. Neurological examination is unremarkable. His CBC reveals a hemoglobin of 8.5 g/dL (14-18g/dL), MCV of 72 fL (80-100 fL), RDW of 22 % (11-15%), serum iron: 35 µg/dL (60-170 µg/dL), TIBC of 550 µg/dL (normal: 240-450 µg/dL) and transferrin saturation of 11% (normal: 20-50%). His WBC and platelets are normal in quantity and morphology. What exam should be performed next?
B. Colonoscopy exam
C. Hemoglobin electrophoresis
D. Renal function panel
E. Serum lead test
9. Use this case for the next four questions. A 52-year-old man presents to the clinic with fatigue and weakness for the past 6 months. His past medical history is unremarkable. He has been drinking 5 glasses of wine each day for the last 30 years. He denies any gastrointestinal bleeding or significant changes in his diet. Physical examination reveals pale skin and mucosa. There are no signs of jaundice or hepatosplenomegaly. Neurological examination is unremarkable. His laboratory results are listed below.
MCV: 75 fL (80-100 fL)
Serum iron: 190 µg/dL (60-170 µg/dL)
TIBC: 250 µg/dL (240-450 µg/dL)
Transferrin saturation: 60% (20-50%)
Serum ferritin: 800 ng/mL (30-400 ng/mL)
His WBC and platelets are normal in quantity and morphology. What exam need to be performed next?
B. Colonoscopy exam
C. Hemoglobin electrophoresis
D. Renal function panel
E. Serum lead test
10. A 52-year-old man presents to the clinic with fatigue and weakness for the past 6 months. His past medical history is unremarkable. He has been drinking 5 glasses of wine each day for the last 30 years. He denies any gastrointestinal bleeding or significant changes in his diet. Physical examination reveals pale skin and mucosa. There are no signs of jaundice or hepatosplenomegaly. Neurological examination is unremarkable. His laboratory results are listed below.
MCV: 75 fL (80-100 fL)
Serum iron: 190 µg/dL (60-170 µg/dL)
TIBC: 250 µg/dL (240-450 µg/dL)
Transferrin saturation: 60% (20-50%)
Serum ferritin: 800 ng/mL (30-400 ng/mL)
His WBC and platelets are normal in quantity and morphology. Bone marrow biopsy reveals hematopoietic precursors with cytoplasmic vacuoles. No significant dysplasia is noted. An image of his marrow aspiration with iron stain is shown. What is most likely associated with these findings?
(Image credit: Paulo Henrique Orlandi Mourao, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)
B. Hemoglobinopathy
C. Iron deficiency
D. Lead poisoning
E. Vitamin B12 deficiency
11. A 52-year-old man presents to the clinic with fatigue and weakness for the past 6 months. His past medical history is unremarkable. He has been drinking 5 glasses of wine each day for the last 30 years. He denies any gastrointestinal bleeding or significant changes in his diet. Physical examination reveals pale skin and mucosa. There are no signs of jaundice or hepatosplenomegaly. Neurological examination is unremarkable. His laboratory results are listed below.
Hemoglobin: 10.5 g/dL (13.5-17.5 g/dL)
MCV: 75 fL (80-100 fL)
Serum iron: 190 µg/dL (60-170 µg/dL)
TIBC: 250 µg/dL (240-450
µg/dL)
Transferrin saturation: 60% (20-50%)
Serum ferritin: 800 ng/mL (30-400 ng/mL)
His WBC and platelets are normal in quantity and morphology. Bone marrow biopsy reveals hematopoietic precursors with cytoplasmic vacuoles. No significant dysplasia is noted. An image of his marrow aspiration with iron stain is shown. What is the cause of his marrow iron studies?
(Image credit: Paulo Henrique Orlandi Mourao, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)
B. Hemoglobin aggregates
C. Macrophage activation
D. Iron utilization defects
E. Reduced DNA synthesis
12. A 52-year-old man presents to the clinic with fatigue and weakness for the past 6 months. His past medical history is unremarkable. He has been drinking 5 glasses of wine each day for the last 30 years. He denies any gastrointestinal bleeding or significant changes in his diet. Physical examination reveals pale skin and mucosa. There are no signs of jaundice or hepatosplenomegaly. Neurological examination is unremarkable. His laboratory results are listed below.
Hemoglobin: 10.5 g/dL (13.5-17.5 g/dL)
MCV: 75 fL (80-100 fL)
Serum iron: 190 µg/dL (60-170 µg/dL)
TIBC: 250 µg/dL (240-450
µg/dL)
Transferrin saturation: 60% (20-50%)
Serum ferritin: 800 ng/mL (30-400 ng/mL)
His WBC and platelets are normal in quantity and morphology. Bone marrow biopsy reveals hematopoietic precursors with cytoplasmic vacuoles. No significant dysplasia is noted. An image of his marrow aspiration with iron stain is shown. What is the diagnosis?
(Image credit: Paulo Henrique Orlandi Mourao, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)
B. Hemoglobin C disease
C. Iron deficiency anemia
D. Megaloblastic anemia
E. Sideroblastic anemia
13. Use this case for the next four questions. A 65-year-old woman presents to the clinic with fatigue, weakness, and tingling in her hands and feet for the past three months. She has a sore tongue and occasional difficulty walking during this period. She has had auto-immune gastritis for 30 years. Physical examination reveals pallor of skin and conjunctiva, a smooth red tongue, and decreased vibratory sensation and proprioception in her lower extremities. Her laboratory tests are listed below.
MCV: 115 fL (80-100 fL)
White blood cell count: 4,000/mm³ (4,500-11,000/mm³)
Platelet count: 150,000/mm³ (150,000-450,000/mm³)
An image of her peripheral blood smear is shown. What test needs to be performed next?
B. Eosin-5-maleimide binding assay
C. Hemoglobin electrophoresis/HPLC
D. Serum lead test
E. Serum folate and VB12 test
F. Serum iron tests
14. A 65-year-old woman presents to the clinic with fatigue, weakness, and tingling in her hands and feet for the past three months. She has a sore tongue and occasional difficulty walking during this period. She has had auto-immune gastritis for 30 years. Physical examination reveals pallor of skin and conjunctiva, a smooth red tongue, and decreased vibratory sensation and proprioception in her lower extremities. Her laboratory tests are listed below.
MCV: 115 fL (80-100 fL)
White blood cell count: 4,000/mm³ (4,500-11,000/mm³)
Platelet count: 150,000/mm³ (150,000-450,000/mm³)
An image of her peripheral blood smear is shown. Additional tests reveal a serum vitamin B12 of 120 pg/mL (200-900 pg/mL), serum folate of 5.5 ng/mL (3-16 ng/mL). Her iron studies are within normal ranges. What additional test result is likely elevated?
(Image credit: Ed Uthman, CC BY 2.0 https://creativecommons.org/licenses/by/2.0/ via Flickr)
B. Homocysteine
C. Indirect bilirubin
D. Iron
E. Lead
F. TIBC
15. A 65-year-old woman presents to the clinic with fatigue, weakness, and tingling in her hands and feet for the past three months. She has a sore tongue and occasional difficulty walking during this period. She has had auto-immune gastritis for 30 years. Physical examination reveals pallor of skin and conjunctiva, a smooth red tongue, and decreased vibratory sensation and proprioception in her lower extremities. Her laboratory tests are listed below.
MCV: 115 fL (80-100 fL)
White blood cell count: 4,000/mm³ (4,500-11,000/mm³)
Platelet count: 150,000/mm³ (150,000-450,000/mm³)
An image of her peripheral blood smear is shown. Additional tests reveal a serum vitamin B12 of 120 pg/mL (200-900 pg/mL), serum folate of 5.5 ng/mL (3-16 ng/mL). Her iron studies are within normal ranges. What is the cause of her peripheral blood findings?
(Image credit: Ed Uthman, CC BY 2.0 https://creativecommons.org/licenses/by/2.0/ via Flickr)
B. Hemoglobinopathy
C. Inhibition of δ-aminolevulinate dehydratase
D. Iron deficiency
E. Red cell membrane instability
16. A 65-year-old woman presents to the clinic with fatigue, weakness, and tingling in her hands and feet for the past three months. She has a sore tongue and occasional difficulty walking during this period. She has had auto-immune gastritis for 30 years. Physical examination reveals pallor of skin and conjunctiva, a smooth red tongue, and decreased vibratory sensation and proprioception in her lower extremities. Her laboratory tests are listed below.
MCV: 115 fL (80-100 fL)
White blood cell count: 4,000/mm³ (4,500-11,000/mm³)
Platelet count: 150,000/mm³ (150,000-450,000/mm³)
An image of her peripheral blood smear is shown. Additional tests reveal a serum vitamin B12 of 120 pg/mL (200-900 pg/mL), serum folate of 5.5 ng/mL (3-16 ng/mL). Her iron studies are within normal ranges. What is the cause of her abnormal serum VB12 level?
(Image credit: Ed Uthman, CC BY 2.0 https://creativecommons.org/licenses/by/2.0/ via Flickr)
B. Celiac disease
C. Chronic pancreatic insufficiency
D. Consumption of overcooked food
E. Hemoglobinopathy
17. A 65-year-old woman presents to the clinic with fatigue, weakness, and tingling in her hands and feet for the past three months. She has a sore tongue and occasional difficulty walking during this period. She has had auto-immune gastritis for 30 years. Physical examination reveals pallor of skin and conjunctiva, a smooth red tongue, and decreased vibratory sensation and proprioception in her lower extremities. Her laboratory tests are listed below.
MCV: 115 fL (80-100 fL)
White blood cell count: 4,000/mm³ (4,500-11,000/mm³)
Platelet count: 150,000/mm³ (150,000-450,000/mm³)
An image of her peripheral blood smear is shown. Additional tests reveal a serum vitamin B12 of 120 pg/mL (200-900 pg/mL), serum folate of 5.5 ng/mL (3-16 ng/mL). Her iron studies are within normal ranges. What is the diagnosis?
(Image credit: Ed Uthman, CC BY 2.0 https://creativecommons.org/licenses/by/2.0/ via Flickr)
B. Hemoglobinopathy
C. Iron deficiency anemia
D. Pernicious anemia
E. Sideroblastic anemia
Comments
Post a Comment