Abnormal Iron Metabolism (Chatgpt)

*Question: Which protein is responsible for exporting iron from enterocytes into the bloodstream?
A) Transferrin
B) Ferritin
C) Ferroportin
D) Hepcidin

*Answer: C) Ferroportin

*Question: Hepcidin is primarily produced by which organ?
A) Kidney
B) Liver
C) Spleen
D) Bone marrow

*Answer: B) Liver

*Question: The main function of transferrin is to:
A) Store iron
B) Export iron
C) Transport iron in plasma
D) Absorb iron from the intestine

*Answer: C) Transport iron in plasma

*Question: Ferritin serves as the main:
A) Iron transporter
B) Iron storage molecule
C) Iron export protein
D) Iron absorption regulator

*Answer: B) Iron storage molecule

*Question: Which form of iron is absorbed by enterocytes?
A) Ferric (Fe3+) only
B) Ferrous (Fe2+)
C) Heme-bound Fe only
D) Elemental Fe0

*Answer: B) Ferrous (Fe2+)

*Question: Hepcidin decreases serum iron by causing degradation of:
A) Ferritin
B) Hemoglobin
C) Ferroportin
D) Transferrin

*Answer: C) Ferroportin

*Question: Lactoferrin has a higher affinity for iron than transferrin. It is contained in which cells?
A) Lymphocytes
B) Neutrophils
C) Eosinophils
D) Basophils

*Answer: B) Neutrophils

*Question: A rise in hepcidin causes iron to be sequestered in which cells?
A) Platelets
B) Macrophages and hepatocytes
C) Endothelial cells
D) Myocytes

*Answer: B) Macrophages and hepatocytes

*Question: Iron deficiency stimulates which protein on developing erythroblasts to increase iron uptake?
A) Ferritin
B) sTfR (soluble transferrin receptor)
C) Hepcidin
D) Lactoferrin

*Answer: B) sTfR (soluble transferrin receptor)

*Question: In iron metabolism, which protein binds heme iron inside cells to prevent free radical damage?
A) Ferritin
B) Hemosiderin
C) Transferrin
D) Lactoferrin

*Answer: A) Ferriti

*Question: The earliest stage of iron deficiency involves depletion of which iron compartment first?
A) Transport iron
B) Storage iron
C) Functional iron
D) Hemoglobin iron

*Answer: B) Storage iron

*Question: The most common global cause of iron deficiency anemia is:
A) High calcium intake
B) Chronic inflammation
C) Chronic blood loss
D) Genetic defects

*Answer: C) Chronic blood loss

*Question: A hallmark feature of IDA on CBC is:
A) Macrocytosis
B) Reticulocytosis
C) Microcytic, hypochromic RBCs
D) Auer rods

*Answer: C) Microcytic, hypochromic RBCs

*Question: Iron deficiency anemia shows what pattern on iron studies?
A) Ferritin ↑, TIBC ↓
B) Ferritin ↓, TIBC ↑
C) Ferritin ↑, Serum iron ↑
D) Ferritin normal, TIBC normal

*Answer: B) Ferritin ↓, TIBC ↑

*Question: Which symptom is classic in IDA?
A) Bronze skin
B) Koilonychia
C) Splenomegaly
D) Jaundice

*Answer: B) Koilonychia

*Question: Pica in IDA usually manifests as craving for:
A) Milk
B) Ice or clay
C) Fruits
D) Sweets

*Answer: B) Ice or clay

*Question: In early IDA, serum ferritin is:
A) Increased
B) Normal or low
C) High only in men
D) High only in pregnancy

*Answer: B) Normal or low

*Question: Reticulocyte count in IDA typically appears:
A) High
B) Normal
C) Low
D) Variable

*Answer: C) Low

*Question: Which condition increases risk for IDA due to impaired absorption?
A) Hemochromatosis
B) Celiac disease
C) Polycythemia
D) G6PD deficiency

*Answer: B) Celiac disease

*Question: Which RBC morphology is characteristic in severe IDA?
A) Spherocytes
B) Burr cells
C) Pencil cells
D) Target cells

*Answer: C) Pencil cells

*Question: IDA typically presents with hemoglobin values:
A)

*Answer: B) Mild, moderate, or severe

*Question: Serum transferrin in IDA is:
A) Increased
B) Decreased
C) Normal
D) Absent

*Answer: A) Increased

*Question: Which population has the highest iron requirements?
A) Adult males
B) Postmenopausal females
C) Pregnant women
D) Elderly men

*Answer: C) Pregnant women

*Question: The gold standard for diagnosing IDA is:
A) Serum iron
B) Bone marrow iron stain
C) Ferritin
D) CBC

*Answer: B) Bone marrow iron stain

*Question: In IDA, RDW is usually:
A) Decreased
B) Normal
C) Increased
D) Unchanged

*Answer: C) Increased

*Question: Chronic IDA is associated with increased levels of:
A) ZPP (Zinc protoporphyrin)
B) Hemoglobin F
C) MCHC
D) Serum calcium

*Answer: A) ZPP

*Question: Plummer-Vinson syndrome includes all except:
A) Dysphagia
B) Iron deficiency anemia
C) Esophageal webs
D) Splenomegaly

*Answer: D) Splenomegaly

*Question: IDA RBCs appear on smear as:
A) Hyperchromic
B) Hypochromic
C) Normochromic
D) Polychromatophilic

*Answer: B) Hypochromic

*Question: First-line treatment for IDA is:
A) IV iron only
B) Blood transfusion
C) Oral iron supplementation
D) Steroids

*Answer: C) Oral iron supplementation

*Question: Expected reticulocyte response to iron therapy occurs in:
A) 1 day
B) 3–5 days
C) 3 weeks
D) 8 weeks

*Answer: B) 3–5 day

*Question: The central mechanism of anemia of inflammation involves increased:
A) Ferritin breakdown
B) Hepcidin production
C) Ferroportin expression
D) EPO secretion

*Answer: B) Hepcidin production

*Question: Hepcidin is stimulated by which cytokine?
A) IL-4
B) IL-6
C) IL-2
D) IL-10

*Answer: B) IL-6

*Question: In ACI, serum iron is low because iron is:
A) Excreted in urine
B) Lost through bleeding
C) Sequestered in macrophages
D) Not absorbed from the stomach

*Answer: C) Sequestered in macrophages

*Question: ACI typically shows what ferritin level?
A) Low
B) Normal to high
C) Always normal
D) Absent

*Answer: B) Normal to high

*Question: TIBC in ACI is characteristically:
A) Increased
B) Decreased
C) Normal
D) Absent

*Answer: B) Decreased

*Question: A hallmark of ACI is:
A) Iron overload
B) Functional iron deficiency
C) Excess ferroportin
D) Increased RBC survival

*Answer: B) Functional iron deficiency

*Question: Which acute phase reactant competes strongly for iron in inflammation?
A) Hemoglobin
B) Albumin
C) Lactoferrin
D) Globulin

*Answer: C) Lactoferrin

*Question: ACI RBC morphology is typically:
A) Microcytic only
B) Normocytic normochromic
C) Macrocytic
D) Spherocytic

*Answer: B) Normocytic normochromic

*Question: Coexisting IDA in ACI leads to cells that are:
A) Macrocytic
B) Microcytic hypochromic
C) Tear drop-shaped
D) Fragmented

*Answer: B) Microcytic hypochromic

*Question: Which inflammatory cytokines impair erythropoiesis?
A) TNF-α, IL-1, IF-γ
B) IL-4, IL-5
C) IL-2, IL-12
D) IL-7, IL-3

*Answer: A) TNF-α, IL-1, IF-γ

*Question: RBC lifespan in ACI is:
A) Increased
B) Normal
C) Slightly shortened
D) Severely shortened

*Answer: C) Slightly shortened

*Question: sTfR in ACI is typically:
A) High
B) Low
C) Normal
D) Absent

*Answer: C) Normal

*Question: Reticulocyte count in ACI is:
A) High
B) Normal
C) Low
D) Variable

*Answer: C) Low

*Question: Bone marrow in ACI shows iron located mainly in:
A) Erythroblasts
B) Macrophages
C) Plasma cells
D) Megakaryocytes

*Answer: B) Macrophages

*Question: The anemia of chronic inflammation is best described as:
A) Sideropenia with abundant iron stores
B) Total iron depletion
C) Excess iron absorption
D) Genetic enzyme defect

*Answer: A) Sideropenia with abundant iron store

*Question: IRIDA (Iron-Refractory Iron Deficiency Anemia) is caused by mutations in:
A) ALAS2
B) Ferroportin
C) TMPRSS6 (Matriptase-2)
D) HFE

*Answer: C) TMPRSS6 (Matriptase-2)

*Question: IRIDA results in inappropriately high levels of:
A) Transferrin
B) Hepcidin
C) Ferritin
D) EPO

*Answer: B) Hepcidin

*Question: Patients with IRIDA typically respond poorly to:
A) Oral iron
B) IV iron
C) RBC transfusion
D) Folate

*Answer: A) Oral iron

*Question: IRIDA iron studies resemble:
A) IDA
B) ACI
C) Hemochromatosis
D) Lead poisoning

*Answer: A) IDA

*Question: A key feature suggesting IRIDA over IDA is:
A) Normal ferritin
B) Very low ferritin
C) High TIBC
D) No response to oral iron

*Answer: D) No response to oral iro

*Question: The hallmark of sideroblastic anemia is:
A) Hypersegmented neutrophils
B) Ring sideroblasts
C) Heinz bodies
D) Howell-Jolly bodies

*Answer: B) Ring sideroblasts

*Question: Ring sideroblasts represent iron-laden:
A) Ribosomes
B) Mitochondria
C) Golgi bodies
D) Nuclei

*Answer: B) Mitochondria

*Question: The gold standard stain for detecting ring sideroblasts is:
A) Wright stain
B) Giemsa stain
C) Perl’s Prussian Blue stain
D) PAS stain

*Answer: C) Perl’s Prussian Blue stain

*Question: The most common inherited sideroblastic anemia is caused by mutation in:
A) HFE
B) ALAS2
C) TMPRSS6
D) Ferrochelatase

*Answer: B) ALAS2

*Question: ALAS2 requires which vitamin as a cofactor?
A) B1
B) B3
C) B6
D) B12

*Answer: C) B6

*Question: Some ALAS2 mutations show improvement with:
A) Folic acid
B) Pyridoxine
C) EPO
D) Iron chelation

*Answer: B) Pyridoxine

*Question: Sideroblastic anemia RBCs can be:
A) Microcytic or macrocytic
B) Always microcytic
C) Always macrocytic
D) Normocytic only

*Answer: A) Microcytic or macrocytic

*Question: Acquired sideroblastic anemia can be caused by:
A) Bacteria
B) Alcohol and certain drugs
C) Hyperthyroidism
D) Folic acid

*Answer: B) Alcohol and certain drugs

*Question: In sideroblastic anemia, iron is abundant in:
A) Plasma
B) Hepatocytes only
C) Bone marrow
D) Urine

*Answer: C) Bone marrow

*Question: Electron microscopy shows iron deposits in sideroblasts located in:
A) Golgi apparatus
B) Mitochondria
C) Nucleus
D) Endoplasmic reticulum

*Answer: B) Mitochondri

*Question: Lead inhibits which enzyme converting ALA to PBG?
A) ALAS
B) ALA dehydratase
C) Ferrochelatase
D) Uroporphyrinogen decarboxylase

*Answer: B) ALA dehydratase

*Question: Lead also inhibits which enzyme responsible for incorporating iron into protoporphyrin IX?
A) ALAS
B) ALA dehydratase
C) Ferrochelatase
D) PBG deaminase

*Answer: C) Ferrochelatase

*Question: A classic peripheral smear finding in lead poisoning is:
A) Howell-Jolly bodies
B) Basophilic stippling
C) Spherocytes
D) Schistocytes

*Answer: B) Basophilic stippling

*Question: Basophilic stippling occurs due to inhibition of which enzyme?
A) Pyrimidine-5'-nucleotidase
B) LDH
C) G6PD
D) PBG synthase

*Answer: A) Pyrimidine-5'-nucleotidase

*Question: The anemia caused by lead poisoning is initially:
A) Microcytic
B) Normocytic
C) Macrocytic
D) Megaloblastic

*Answer: B) Normocytic

*Question: Chronic lead exposure eventually produces:
A) Macrocytic anemia
B) Microcytic hypochromic anemia
C) Normocytic anemia only
D) Hemolytic anemia only

*Answer: B) Microcytic hypochromic anemia

*Question: FEP/ZPP levels in lead poisoning are:
A) Decreased
B) Normal
C) Increased
D) Unmeasurable

*Answer: C) Increased

*Question: Lead toxicity may affect which organ system most severely in children?
A) Skin
B) CNS
C) Lungs
D) Kidneys

*Answer: B) CNS

*Question: Chelation therapy for lead poisoning uses:
A) Desferrioxamine
B) Calcium disodium EDTA
C) Deferasirox
D) Oral iron

*Answer: B) Calcium disodium EDTA

*Question: Lead interferes with the heme synthesis pathway leading to accumulation of:
A) ALA and protoporphyrin
B) Hemoglobin F
C) Ferritin
D) Cytochrome proteins

*Answer: A) ALA and protoporphyri

*Question: Primary hemochromatosis is most commonly caused by mutations in:
A) ALAS2
B) HFE gene
C) TMPRSS6
D) Ferroportin gene

*Answer: B) HFE gene

*Question: Iron overload primarily damages organs via:
A) Insulin resistance
B) Autoimmune attack
C) Fenton reaction and free radical formation
D) High blood viscosity

*Answer: C) Fenton reaction and free radical formation

*Question: The earliest laboratory abnormality in hereditary hemochromatosis is:
A) High hemoglobin
B) Increased transferrin saturation
C) High MCHC
D) Decreased ferritin

*Answer: B) Increased transferrin saturation

*Question: A common manifestation of hemochromatosis is:
A) Blue sclera
B) Bronzed diabetes
C) Gout
D) Tetany

*Answer: B) Bronzed diabetes

*Question: First-line treatment for hereditary hemochromatosis is:
A) IV iron
B) Phlebotomy
C) Blood transfusion
D) Lactoferrin therapy

*Answer: B) Phlebotomy

*Question: Transfusion-related iron overload is known as:
A) Sideropenia
B) Hemosiderosis
C) Porphyria
D) Hemophagocytosis

*Answer: B) Hemosiderosis

*Question: Each unit of transfused blood contains approximately how much iron?
A) 20–30 mg
B) 50 mg
C) 200–250 mg
D) 500 mg

*Answer: C) 200–250 mg

*Question: Juvenile hemochromatosis is associated with mutations in:
A) Hepcidin or hemojuvelin
B) Ferritin
C) ALAS2
D) Transferrin

*Answer: A) Hepcidin or hemojuvelin

*Question: Excess iron most commonly accumulates in which organ first?
A) Brain
B) Liver
C) Lungs
D) Skin

*Answer: B) Liver

*Question: Serum ferritin is used to monitor:
A) Serum glucose
B) Iron stores
C) RBC fragility
D) Serum potassium

*Answer: B) Iron store

*Question: In ACI, TIBC is:
A) Elevated
B) Normal to low
C) Very high
D) Absent

*Answer: B) Normal to low

*Question: Ferritin is an acute phase reactant and therefore can be:
A) Falsely elevated
B) Falsely decreased
C) Always accurate
D) Unrelated to inflammation

*Answer: A) Falsely elevated

*Question: In IDA, transferrin saturation is:
A) Increased
B) Decreased
C) Normal
D) Absent

*Answer: B) Decreased

*Question: The presence of iron in macrophages but absence in erythroblasts indicates:
A) IDA
B) ACI
C) Hemochromatosis
D) Thalassemia

*Answer: B) ACI

*Question: ZPP is elevated when:
A) Heme synthesis is normal
B) Iron incorporation into heme is impaired
C) RBC count is high
D) Folate levels are low

*Answer: B) Iron incorporation into heme is impaired

*Question: High sTfR strongly suggests:
A) ACI
B) IDA
C) Hemochromatosis
D) Lead toxicity

*Answer: B) IDA

*Question: A low reticulocyte hemoglobin content suggests:
A) Excess iron
B) Iron-restricted erythropoiesis
C) High transferrin levels
D) Increased hepcidin

*Answer: B) Iron-restricted erythropoiesis

*Question: A gold-standard test to assess iron stores in the bone marrow is:
A) Ferritin
B) Prussian blue stain
C) Hemoglobin electrophoresis
D) ESR

*Answer: B) Prussian blue stain

*Question: In IDA, the first lab marker to fall is usually:
A) Serum iron
B) Ferritin
C) TIBC
D) Transferrin saturation

*Answer: B) Ferritin

*Question: A patient with microcytic anemia, normal ferritin, low serum iron, and low TIBC most likely has:
A) IDA
B) ACI
C) Thalassemia
D) IRIDA

*Answer: B) AC