Practice questions Anemia V
Practice questions
Anemia V
© 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 five questions. A 5-year-old boy is brought to the pediatric clinic due to fatigue, irritability, abdominal pain and decreased appetite over the past few months. The mother mentions that they live in an old house built in the 1910s, and she recently discovered peeling paint in the boy's bedroom. Physical examination reveals pale skin and mucosa. His conjunctivae are pale, and there are blue-black lines visible at the gingival margin. Laboratory tests reveal the following:
MCV: 68 fL (80-100 fL)
Reticulocyte count: 1.5% (0.5-2.5%)
An image of his peripheral blood smear is
shown. What test needs to be done next to confirm the diagnosis?
B. Eosin-5-maleimide binding assay
C. Hemoglobin electrophoresis/HPLC
D. Serum lead test
E. Serum folate and VB12 test
F. Serum iron tests
2. A 5-year-old boy is brought to the pediatric clinic due to fatigue, irritability, abdominal pain and decreased appetite over the past few months. The mother mentions that they live in an old house built in the 1910s, and she recently discovered peeling paint in the boy's bedroom. Physical examination reveals pale skin and mucosa. His conjunctivae are pale, and there are blue-black lines visible at the gingival margin. Laboratory tests reveal the following:
MCV: 68 fL (80-100 fL)
Reticulocyte count: 1.5% (0.5-2.5%)
An image of his peripheral blood smear is
shown. Additional studies reveal elevated blood
lead level, and normal serum iron and TIBC. What is most likely found in his
bone marrow?
B. Erythroid precursors with stain-able iron surrounding nuclei
C. Hypocellular marrow largely replaced by adipose tissue
D. Isolated erythroid aplasia
E. Myelofibrosis
3. A 5-year-old boy is brought to the pediatric clinic due to fatigue, irritability, abdominal pain and decreased appetite over the past few months. The mother mentions that they live in an old house built in the 1910s, and she recently discovered peeling paint in the boy's bedroom. Physical examination reveals pale skin and mucosa. His conjunctivae are pale, and there are blue-black lines visible at the gingival margin. Laboratory tests reveal the following:
MCV: 68 fL (80-100 fL)
Reticulocyte count: 1.5% (0.5-2.5%)
An image of his peripheral blood smear is shown. Additional studies reveal elevated blood lead level, and normal serum iron and TIBC. What is most likely causing his CBC findings?
(Image credit: isis325, CC BY 2.0 https://creativecommons.org/licenses/by/2.0/ via Flickr)
B. Erythroid maturation arrest
C. Impaired heme synthesis
D. Increased hemolysis
E. Red cell structural protein defects
4. A 5-year-old boy is brought to the pediatric clinic due to fatigue, irritability, abdominal pain and decreased appetite over the past few months. The mother mentions that they live in an old house built in the 1910s, and she recently discovered peeling paint in the boy's bedroom. Physical examination reveals pale skin and mucosa. His conjunctivae are pale, and there are blue-black lines visible at the gingival margin. Laboratory tests reveal the following:
MCV: 68 fL (80-100 fL)
Reticulocyte count: 1.5% (0.5-2.5%)
An image of his peripheral blood smear is shown. Additional studies reveal elevated blood lead level, and normal serum iron and TIBC. What is most likely causing his low RBC production?
(Image credit: isis325, CC BY 2.0 https://creativecommons.org/licenses/by/2.0/ via Flickr)
B. Deletion of 3 or 4 a globin gene
C. Deletion of 1 or 2 b globin gene
D. Erythroid stem cell damage
E. Inhibition of ferrochelatase
5. A 5-year-old boy is brought to the pediatric clinic due to fatigue, irritability, abdominal pain and decreased appetite over the past few months. The mother mentions that they live in an old house built in the 1910s, and she recently discovered peeling paint in the boy's bedroom. Physical examination reveals pale skin and mucosa. His conjunctivae are pale, and there are blue-black lines visible at the gingival margin. Laboratory tests reveal the following:
MCV: 68 fL (80-100 fL)
Reticulocyte count: 1.5% (0.5-2.5%)
An image of his peripheral blood smear is shown. Additional studies reveal elevated blood lead level, and normal serum iron and TIBC. What is the diagnosis?
(Image credit: isis325, CC BY 2.0 https://creativecommons.org/licenses/by/2.0/ via Flickr)
B. Iron deficiency anemia
C. Lead associated anemia
D. Megaloblastic anemia
E. Reticulocytosis
6. Use this case for the next three questions. A 45-year-old woman presents to the clinic with fatigue, weakness, and shortness of breath on exertion for 3 months. Her past medical history is unremarkable except heavy menstrual periods over the past year. She has a heart rate of 115 bpm. Physical examination reveals pale and conjunctiva. Laboratory results are as follows:
MCV: 70 fL (normal: 80-100 fL)
An image of her peripheral blood smear is shown. What additional lab test result is likely decreased?
B. Indirect bilirubin
C. Red cell distribution width
D. Serum hepcidin
E. TIBC
7. A 45-year-old woman presents to the clinic with fatigue, weakness, and shortness of breath on exertion for 3 months. Her past medical history is unremarkable except heavy menstrual periods over the past year. She has a heart rate of 115 bpm. Physical examination reveals pale and conjunctiva. Laboratory results are as follows:
MCV: 70 fL (normal: 80-100 fL)
An image of her peripheral blood smear is shown. Additional tests reveal a serum ferritin of 8 ng/mL(20-300 ng/mL), serum iron of 25 µg/dL (50-150 µg/dL), TIBC of 480 µg/dL (250-450 µg/dL), transferrin saturation of 5% (15-50%), and hepcidin of 1.5 ng/ml (3.44–24.78 ng/ml). What is the cause of her low hepcidin level?
(Image credit: Erhabor Osaro (Associate Professor), CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)
B. Hemoglobinopathy
C. High red cell distribution width
D. Lead poisoning
E. Low transferrin saturation
8. A 45-year-old woman presents to the clinic with fatigue, weakness, and shortness of breath on exertion for 3 months. Her past medical history is unremarkable except heavy menstrual periods over the past year. She has a heart rate of 115 bpm. Physical examination reveals pale and conjunctiva. Laboratory results are as follows:
MCV: 70 fL (normal: 80-100 fL)
An image of her peripheral blood smear is shown. Additional tests reveal a serum ferritin of 8 ng/mL(20-300 ng/mL), serum iron of 25 µg/dL (50-150 µg/dL), TIBC of 480 µg/dL (250-450 µg/dL), transferrin saturation of 5% (15-50%), and hepcidin of 1.5 ng/ml (3.44–24.78 ng/ml). What is the diagnosis?
(Image credit: Erhabor Osaro (Associate Professor), CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)
B. Anemia of chronic disease
C. Iron deficiency anemia
D. Lead associated anemia
E. Megaloblastic anemia
9. Use this case for the next five questions. A 45-year-old woman presents to the clinic with fatigue and weakness for the past three months. She also reports shortness of breath on exertion and occasional palpitations. She is a strict vegetarian and has been drinking 2 glasses of wine each day for the last 20 years. She has a 15 pack-year history of cigarette smoking. Physical examination reveals pale conjunctivae and a smooth, sore tongue. Neurological examination is normal. Laboratory findings are as follows:
MCV: 110 fL (80-100 fL)
WBC count: 4,500/µL (4,000-11,000/µL)
Platelet count: 150,000/µL (150,000-450,000/µL)
Reticulocyte count: 0.8% (0.5-2.5%)
An image of the peripheral blood smear is shown. What test should 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
10. A 45-year-old woman presents to the clinic with fatigue and weakness for the past three months. She also reports shortness of breath on exertion and occasional palpitations. She is a strict vegetarian and has been drinking 2 glasses of wine each day for the last 20 years. She has a 15 pack-year history of cigarette smoking. Physical examination reveals pale conjunctivae and a smooth, sore tongue. Neurological examination is normal. Laboratory findings are as follows:
MCV: 110 fL (80-100 fL)
WBC count: 4,500/µL (4,000-11,000/µL)
Platelet count: 150,000/µL (150,000-450,000/µL)
Reticulocyte count: 0.8% (0.5-2.5%)
An image of the peripheral blood smear is shown. Further serum tests reveal a folate of 2 ng/ml (5-25 ng/mL) and Vitamin B12 of 350 pg/mL (200-900 pg/mL). What additional test results are likely seen?
(Image credit: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
B. Elevated homocysteine, and normal methylmalonic acid
C. Normal homocysteine, and elevated methylmalonic acid
D. Normal homocysteine, and methylmalonic acid
11. A 45-year-old woman presents to the clinic with fatigue and weakness for the past three months. She also reports shortness of breath on exertion and occasional palpitations. She is a strict vegetarian and has been drinking 2 glasses of wine each day for the last 20 years. She has a 15 pack-year history of cigarette smoking. Physical examination reveals pale conjunctivae and a smooth, sore tongue. Neurological examination is normal. Laboratory findings are as follows:
MCV: 110 fL (80-100 fL)
WBC count: 4,500/µL (4,000-11,000/µL)
Platelet count: 150,000/µL (150,000-450,000/µL)
Reticulocyte count: 0.8% (0.5-2.5%)
An image of the peripheral blood smear is shown. Further serum tests reveal a folate of 2 ng/ml (5-25 ng/mL) and Vitamin B12 of 350 pg/mL (200-900 pg/mL). What is most likely associated with her low folate level?
(Image credit: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
B. Chronic bleeding
C. Cigarette smoking
D. Gastrointestinal tract disorders
E. Vegetarian diet
12. A 45-year-old woman presents to the clinic with fatigue and weakness for the past three months. She also reports shortness of breath on exertion and occasional palpitations. She is a strict vegetarian and has been drinking 2 glasses of wine each day for the last 20 years. She has a 15 pack-year history of cigarette smoking. Physical examination reveals pale conjunctivae and a smooth, sore tongue. Neurological examination is normal. Laboratory findings are as follows:
MCV: 110 fL (80-100 fL)
WBC count: 4,500/µL (4,000-11,000/µL)
Platelet count: 150,000/µL (150,000-450,000/µL)
Reticulocyte count: 0.8% (0.5-2.5%)
An image of the peripheral blood smear is shown. Further serum tests reveal a folate of 2 ng/ml (5-25 ng/mL) and Vitamin B12 of 350 pg/mL (200-900 pg/mL). What is causing her CBC findings?
(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. Precipitation of hemoglobin
E. Red cell membrane instability
13. A 45-year-old woman presents to the clinic with fatigue and weakness for the past three months. She also reports shortness of breath on exertion and occasional palpitations. She is a strict vegetarian and has been drinking 2 glasses of wine each day for the last 20 years. She has a 15 pack-year history of cigarette smoking. Physical examination reveals pale conjunctivae and a smooth, sore tongue. Neurological examination is normal. Laboratory findings are as follows:
MCV: 110 fL (80-100 fL)
WBC count: 4,500/µL (4,000-11,000/µL)
Platelet count: 150,000/µL (150,000-450,000/µL)
Reticulocyte count: 0.8% (0.5-2.5%)
An image of the peripheral blood smear is shown. Further serum tests reveal a folate of 2 ng/ml (5-25 ng/mL) and Vitamin B12 of 350 pg/mL (200-900 pg/mL). 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. Hereditary spherocytosis
C. Iron deficiency anemia
D. Lead associated anemia
E. Megaloblastic anemia
14. Use
this case for the next five questions. A 65-year-old man presents to the clinic with fatigue and generalized weakness for several months. He has a history of type 2 diabetes mellitus, chronic kidney disease stage 3, and Crohn disease. Physical examination reveals pale skin and mucosa. His vital signs are within normal limits. Laboratory results are as follows:
Hemoglobin: 10 g/dL (13.5-17.5 g/dL)
MCV: 85 fL (normal: 80-100 fL)
Serum ferritin: 500 ng/mL (20-300 ng/mL)
TIBC: 200 µg/dL (250-450 µg/dL)
Transferrin saturation: 17% (15-50%)
What additional test result is likely to be elevated?
B. Hepcidin
C. Indirectly bilirubin
D. Serum iron
E. TIBC
15. A 65-year-old man presents to the clinic with fatigue and generalized weakness for several months. He has a history of type 2 diabetes mellitus, chronic kidney disease stage 3, and Crohn disease. Physical examination reveals pale skin and mucosa. His vital signs are within normal limits. Laboratory results are as follows:
Hemoglobin: 10 g/dL (13.5-17.5 g/dL)
MCV: 85 fL (normal: 80-100 fL)
Serum ferritin: 500 ng/mL (20-300 ng/mL)
TIBC: 200 µg/dL (250-450 µg/dL)
Transferrin saturation: 17% (15-50%)
What is the cause of his CBC results?
B. Erythroid stem cell defects
C. Inhibition of heme synthesis
D. Iron deficiency
E. Reduced erythropoietin production
16. A 65-year-old man presents to the clinic with fatigue and generalized weakness for several months. He has a history of type 2 diabetes mellitus, chronic kidney disease stage 3, and Crohn disease. Physical examination reveals pale skin and mucosa. His vital signs are within normal limits. Laboratory results are as follows:
Hemoglobin: 10 g/dL (13.5-17.5 g/dL)
MCV: 85 fL (normal: 80-100 fL)
Serum ferritin: 500 ng/mL (20-300 ng/mL)
TIBC: 200 µg/dL (250-450 µg/dL)
Transferrin saturation: 17% (15-50%)
What is the diagnosis?
B. Hereditary spherocytosis
C. Iron deficiency anemia
D. Lead associated anemia
E. Megaloblastic anemia
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