ANEMIA

Study Questions on Anemia

In iron deficiency anemia the inital abnormality is in:

  1. MCV, MCH, MCHC
  2. Serum iron and total iron binding capacity
  3. Bone marrow iron stores
  4. Peripheral blood smear
  5. Enzyme systems such as cytochrome system

Most suggestive of iron-deficiency anemia is a decreased:

  1. Serum iron and increased iron-binding capacity
  2. Serum iron and normal iron-binding capacity
  3. Serum iron and decreased iron-binding capacity
  4. Iron-binding capacity
  5. 2 and 3

Untreated pernicious anemia may be characterized by all of the following EXCEPT:

  1. Iron deficiency
  2. Folate deficiency
  3. Lead poisoning
  4. Fanconi's anemia
  5. Pernicious anemia

The best next step in an adult with microcytic anemia, low serum iron, and elevated transferrin is to:

  1. Give only iron therapy
  2. Give only B12 therapy
  3. Give only folate therapy
  4. Do diagnostic tests to identify the source of iron loss
  5. Do a Schilling test

A 60-year-old male has severe macrocytic anemia with megaloblastic changes in the bone marrow. The best conclusion is:

  1. Vitamin B12 deficiency exists, treat eith vitamin B12
  2. Folic acid deficiency exists, treat with folic acid
  3. This patient has pernicious anemia, treat with vitamin B12
  4. Either vitamin B12 or folic acid deficiency exists; study the patient further
  5. Nothing of significance can be learned about this patient; treat immediately with vitamin B12, liver extract and folic acid

A distinctly elevated absolute reticulocyte count excludes a diagnosis of:

  1. Recent lare hemorrhage
  2. Hemolytic anemia
  3. Recent treated folic acid deficiency
  4. An active bone marrow
  5. Aplastic anemia

Iron deficiency anemia commonly presents with hypochromic, microcytic red cells. Hypochromic, microcytic anemia may also occur with:

  1. Chronic disease
  2. Familiam sideroblastic anemia
  3. Thalassemia major
  4. All of the above
  5. 1 and 3

In anemia and polycythemia, the measurement of the rate of red cell production is of considerable diagnostic and therapeutic importance. The easiest to measure and often the best gauge of erythroid activity is the:

  1. Mean corpuscular hemoglobin concentration
  2. Measurement of erythropoietin
  3. Reticulocyte count
  4. 2,3 diphosphyglycerate level
  5. Urinary urobilinogen level

Both in iron deficiency and in the anemia of chronic infection there may be hypochromic, microcytic anemia and low serum iron. As a general rule, in chronic disease:

  1. The serum ferritin is low and the iron binding capacity is high
  2. Both serum ferritin and the iron binding capacity is low
  3. Both serum ferritin and the iron binding capacity is high
  4. The serum ferritin is high and the iron binding capacity is low
  5. Both serum ferritin and the iron binding capacity are normal

All of the following are characteristic of the anemia of chronic disease such as tuberculosis, osteomyelitis, or rheumatoid arthritis EXCEPT:

  1. Low serum iron
  2. Decreased marrow iron
  3. Low iron binding capacity or transferrin
  4. Reticulocyte index less than 2%
  5. Normal or hypochromic microcytic erythrocytes on peripheral smear

In megaloblastic anemia the:

  1. Reticulocyte index is usually greater than 3%
  2. MCV (mean cirpuscular volume) is usually greater than 100 cu mincrons (normal 85-99)
  3. MCHC (mean corpuscular hemoglobin concentration) is greater than 32% (normal 30-32)
  4. Schilling test is always abnormal
  5. Cellularity of the bone marrow is normal or decreased

A 45-year-old male has a two-year history of active rheumatoid arthritis treated with aspirin. The hemoglobin concentration two months ago was 11 gm/100ml. The most reliable test for distinguishing iron-deficiency anemia from the anemia of chronic inflammatory disease is:

  1. Serum iron and total serum iron-binding capacity
  2. Mean corpuscular volume of the read cells
  3. Measurement of serum cobalt level
  4. Bone marrow examination and serum ferritin
  5. Serum iron

Sickle cell anemia is usually associated with all of the following EXCEPT:

  1. Hemoglobin S
  2. Positive sickelex test
  3. Normal reticulocyte count
  4. Shortened erythrocyte life span
  5. Normal MCHC

A recurrent difficulty in evaluating anemia is distinguishing between iron deficiency and the anemia of chronic disease. X Y A FE 10 TIBC 450 I FE deficiency B FE 10 TIBC 250 II Chronic disease C FE 60 TIBC 270 III Normal D FE 250 TIBC 260 IV Hemochromatosis The correct match of lab results in column X with conditions in column Y is:

  1. I-C, II-D, III-A, IV-B
  2. I-B, II-A, III-C, IV-D
  3. I-A, II-B, III-C, IV-D
  4. I-D, II-A, III-B, IV-C
  5. I-A, II-C, III-D, IV-B

A black male developed a urinary tract infection and was treated with a sulfonamide antibiotic. After seven days his hemoglobin had decreased from 14.7 to 10 gm/100 ml. The most likely cause of hemolysis in this patient is:

  1. Sickle cell disease
  2. Thalassemia minor
  3. Hereditary spherocytosis
  4. Glucose 6-phosphate dehydrogenase deficiency
  5. Coombs positive hemolytic anemia

In determining the cause of iron deficiency anemia, the most useful aid is a(an):

  1. Serum iron and iron-binding capacity
  2. Reticulocyte count
  3. History and physical examination
  4. X-ray of the gastrointestinal tract
  5. Examination of the blood film

Anemia secondary to vitamin B12 deficiency is always characterized by:

  1. Atrophic gastritis
  2. Lack of intrinsic factor
  3. Demyelination of the posterior and lateral corticospinal tracts
  4. Specific antibodies to intrinsci factor
  5. Megaloblastic bone marrow morphology

An immune hemolytic process can be diagnosed by:

  1. Marked reticulocytosis
  2. Erythroid hyperplasia of bone marrow
  3. Fragmented RBC's in peripheral blood smear
  4. Demonstration of Heinz bodies
  5. Positive direct antiglobulin (Coomb's) test

In the anemia of chronic disease the expected combination of parameters would be:

  1. High serum iron; low TIBC; low marrow iron stores
  2. High serum iron; high TIBC; high marrow iron stores
  3. Low serum iron; low TIBC; low marrow iron stores
  4. Low serum iron; low TIBC; high marrow iron stores
  5. None of the above

All of the following may be associated with iron deficiency anemia EXCEPT:

  1. Hypochromia
  2. Low serum iron
  3. Chronic blood loss
  4. Increased marrow iron stores
  5. Carcinoma of the colon

The correct match of the type of anemia with the expected red cell morphology is: 1. Iron deficiency A. Normocytic normochromic 2. Sideroblastic B. Microcytic hypochromic 3. Folic acid deficiency C. Macrocytic normochromic 4. Anemia of chronic renal failure 5. Thalassemia

  1. 1-B; 2-A; 3-C; 4-B; 5-A
  2. 1-C; 2-B; 3-C; 4-A; 5-A
  3. 1-B; 2-A; 3-C; 4-C; 5-B
  4. 1-B; 2-B; 3-C; 4-A; 5-B
  5. 1-B; 2-B; 3-C; 4-B; 5-B