Fitzgerald questions for hematology

Question 1

Worldwide which of the following is the most common type of anemia?
A. Pernicious anemia
B. Folate deficiency anemia
C. Anemia of chronic disease 
D. Iron deficiency anemia

Answer 1

D. Iron deficiency anemia

Question 2

Most of the body’s iron is obtained from?
A. Animal based food sources
B. Recycled iron content from aged red blood cells
C. Endoplasmic reticulum production
D. Vegetable based food sources

Answer 2

B. Recycled iron content from aged red blood cells

Question 3

Which of the following is most consistent with iron deficiency anemia?
A. Low mean corpuscular volume (MCV), normal mean corpuscular hemoglobin (MCH)
B. Low MCV, low MCH
C. Low MCV, elevated MCH
D. Normal MCV, normal MCH

Answer 3

B.

Question 4

One of the earliest laboratory markers in evolving macrocytic or microcytic anemia is?
A. An increase in RBC distribution width (RDW)
B. A reduction in measurable hemoglobin
C. A low MCH level
D. An increased platelet count

Answer 4

A.

Question 5

A 48 year old woman developed iron deficiency anemia after excessive peri menopausal bleeding, successfully treated by endometrial ablation. Her hematocrit level is 25% and she is taking iron therapy.  At 5 days into therapy one possible observed change in laboratory parameters would include
A. A correction of mean cell volume
B. An 8% increase in Hct level
C. Reticulocytosis 
D. A correction in ferritin level

Answer 5

C.

Question 6

A healthy 34 year old man asks whether he should take an iron supplement. You respond that
A. This is a prudent measure to ensure health
B. Iron deficiency anemia is a common problem in men at this age
C. Use of an iron supplement in the absence of a documented deficiency can lead to iatrogenic iron overload
D. Excess iron is easily excreted

Answer 6

C.

Question 7

Which of the following is the best advice on taking ferrous sulfate to enhance iron absorption 
A. Take with other medications 
B. Take on a full stomach 
C. Take on an empty stomach 
D. Do not take with vitamin c

Answer 7

C.

Question 8

A 40 year old woman with pyelonphritis is taking two medications: cipro and ferrous sulfate (for iron deficiency anemia). She asks about taking both medications and you advise
A. She should take the medicines with a large glass of water
B. An inactive drug compound is potentially formed if the two medications are taken together
C. She can take the medications together to enhance adherence to therapy
D. The ferrous sulfate potentially slows GI motility and results in enhanced cipro absorption

Answer 8

B.

Question 9

One month into therapy for pernicious anemia you wish to check the efficacy of the intervention.  The best lab test to order at this point is
A. Schilling test
B. Hgb measurement 
C. Reticulocyte count 
D.serum cobalamin

Answer 9

B.

Question 10

Folate deficiency anemia causes which of the following changes in RBC indices?
A.  Microcytic, normochromic
B. Normocytic, normochromic
C. Microcytic, hypochromic
D. Macrocytic, normochromic

Answer 10

D.

Question 11

Pernicious anemia is usually caused by
A. Dietary deficiency of vitamin B 12
B. Lack of production of intrinsic factor by the gastric mucosa
C. RBC enzyme deficiency
D. A combination of micronutrient deficiencies caused by malabsorption

Answer 11

B.

Question 12

Pernicious anemia causes which of the following 
A. Microcytic, normochromic
B. Normocytic, normochromic
C. Microcytic, hypochromic
D. Macrocytic, normochromic

Answer 12

D.

Question 13

Common physical exam findings in patients with pernicious anemia include:
A. Hypoactive bowel sounds
B. Stocking glove neuropathy
C. Thin, spoon shaped nails
D. Retinal hemorrhages

Answer 13

B.

Question 14

You examine  A 47-year-old man who presents with difficulty initiating and maintaining sleep and chronic pharyngeal erythema with the following results on hemogram
Hgb 15g (13.5-17.5)
Hct 45% (38.8-50)
RBC 4.2 million (4.3-5.7 million)
MCV 108 fL (80-100)
MCHC 33.2 (32-36%)
These values are most consistent with
A. Pernicious anemia 
B. Alcohol abuse 
C. Thalassemia minor
D. Fanconi disease

Answer 14

B.

Question 15

You examine a 22 year old woman of Asian ancestry. She has no presenting complaint. Hemogram results are as follows
Hgb 9.1 (12-15.5)
Hct 28% (36-42%)
RBC 5 million (3.5-5)
MCV 68 (80-100)
MCHC 33.2 (32-36%)
RDW 13% (11-15)
Reticulocytes 1.5% 
This is most consistent with lab assessment of 
A. Iron deficiency anemia 
B. Cooley anemia 
C. Alpha thalassemia minor
D. Hgb Bart's

Answer 15

C.

Question 16

Hey 68-year-old man who is usually help he presents with new onset of huffing and puffing with exercise for the past three weeks. Physical examination reveals conjunctiva pallorand hemic murmur. Hemogram results are as follows 
Hgb 7.6
Hct 20.5%
RBC 2.1 million
MCV 76
MCHC 28g
RDW 18.4%
Reticulocytes 1.8%
The most likely cause of these findings is 
A. Poor nutrition 
B. Occult blood loss
C. Malabsorption 
D. Chronic inflammation

Answer 16

B.

Question 17

You examine a 57-year-old woman with rheumatoid arthritis who is on disease modifying antirheumatic disease medication but continues to have poor disease control and find the following results on Hemogram
Hgb 10.5
Hct 33%
RBC 3.1 million
MCV 88
MCHC 32.8
RDW 12.2%
Reticulocytes 0.8%

Answer 17

B.

Question 18

You examine a 27-year-old woman with menorrhagia who is otherwise well and know the final results on Hemogram
Hgb 10.1
Hct 32%
RBC 2.9 million 
MCV 72 (80-100)
MCHC 28.2 (32-36%)
RDW 18.9% (11-15)
 Physical exam is likely to include 
A.conjunctiva pallor
B. hemic murmur
C. tachycardia 
D. No specific anemia related findings

Answer 18

D.

Question 19

Results of hemogram  in a person with anemia of chronic disease include 
A. Microcytosis 
B. Anisocytosis
C. Reticulocytopenia 
D. Macrocytosis

Answer 19

C.

Question 20

Which of the following conditions is unlikely to result in anemia of chronic disease? 
A.  Rheumatoid arthritis 
B.  Peripheral vascular disease 
C.  Chronic renal insufficiency 
D.  Osteomyelitis

Answer 20

B.

Question 21

In health, the ratio of hemoglobin to hematocrit is usually 
A. 1:1
B. 1:2
C. 1:3
D. 1:4

Answer 21

C.

Question 22

An increase in the normal variation of RBC size is known as
A. Poikilocytosis
B. Granulation 
C. Anisocytosis 
D. Basophilc stippling

Answer 22

C.

Question 23

Intervention in anemia of chronic disease most often includes;
A. oral vitamin B12
B. treatment of the underlying cause
C. transfusion
D. parenteral iron

Answer 23

B.

Question 24

Poikilocytosis refers to alterations in red blood cells
A. thickness
B. color
C. shape
D. size

Answer 24

C

Question 25

Which of the following is not consistent with anemia of chronic disease:
A. normal RDW
B. normal MCHC
C. hct less than 24%
D. normal to slightly elevated serum ferritin

Answer 25

C.

Question 26

When the cause of macrocytic anemia is uncertain, the most commonly recommended additional testing includes which of the following:
A. haptoglobin and reticulocyte count
B. Schilling test and gastric biopsy
C. methylmalonic acid and homocysteine
D. transferrin and prealbumin

Answer 26

C.

Question 27

True/false

anemia in children is potentially associated with poorer school performance

Answer 27

true

Question 28

True/false

During pregnancy, folic acid requirements increase twofold to fourfold

Answer 28

True

Question 29

True/false

The RBC content is approximately 90% hemoglobin

Answer 29

True

Question 30

True/false

Approximately 90% of the body’s erythropoietin is produced by the kidney

Answer 30

True

Question 31

True/False

The bodys normative response to anemia is reticulocytopenia

Answer 31

False