Heme Questions

What is the most accurate test to diagnose Aplastic anemia?

1. Complete blood count

2. Bone marrow aspiration

3. Peripheral smear

4. Hemoglobin electrophoresis 

5. Serum protein electrophoresis 

Which of the following is the most common inherited cause of hypercoagubility in the US?

1. Von Willebrand disease

2. Protein C deficiency 

3. Protein S deficiency 

4. Antithrombin III deficiency 

5. Factor V Leiden mutation 

Folate deficiency is classically associated with which type of anemia?

1. Sideroblastic

2. Microcytic

3. Hemolytic

4. Macrocytic

5. Normocytic 

Which of the following is most helpful in the management of Sickle cell crises?

1. Antiarrhythmics 

2. Anticholinergics 

3. Antiemetics

4. Antihistamines

5. Analgesics 

Which of the following has been shown to be most effective in preventing the recurrence of Strokes in children with Sickle cell disease?

1. Enoxaparin

2. Folic acid supplementation

3. Chronic transfusion therapy

4. Clopidogrel 

5. Aspirin

A 7-year-old male is brought to the ER for decreased urine output. His mother states his urine has become tea-colored. 10 days prior, he was complaining of vomiting, colicky abdominal pain, and a few episodes of bloody stools without fever. On examination, pallor is noted. Labs are positive for proteinuria, hematuria, increased BUN, increased creatine, decreased platelets, increased indirect bilirubin, reticulocytosis, schistocytes, and normal PT and PTT. What is the first line of management?

1. Trimethoprim-sulfamethoxazole 

2. Platelet transfusion 

3. IV fluids, electrolyte replacement and admission for supportive therapy

4. Loperamide 

5. Splenectomy  

Immune thrombocytopenic purpura (IPT) is what type of hypersensitivity reaction?

1. Type I (IgE mediated)

2. Type II (cytotoxic)

3. Type III (immune complex)

4. Type IV (delayed) 

Autosplenectomy is a common feature of which of the following?

1. Immune thrombocytopenic purpura 

2. Sickle cell disease

3. Alpha thalassemia

4. Beta thalassemia 

5. Henoch-Schonlein purpura 

Von Williebrand factor binds to which of the following?

1. Tissue factor

2. Antithrombin III

3. Plasmin

4. Glycoprotein GP1b receptor on platelets 

5. Fibrinogen 

Plummer-Vinson syndrome is characterized by?

1. Primary ciliary dyskinesia 

2. Iron deficiency anemia + dysphagia + cervical esophageal web 

3. Signs and symptoms due to cortisol excess

4.  Rheumatoid arthritis + coal workers pneumoconiosis 

5. Autoimmune hemolytic anemia + idiopathic thrombocytopenic purpura 

During genetic counseling of a couple who both have the sickle cell trait, what are the chances of having a child with sickle cell disease?

1. 10%

2. 25%

3. 50%

4. 75%

5. 100%

Which of the following disorders is associated with a decreased production of Hepcidin?

1. Anemia of chronic disease

2. Von Willebrand disease

3. Hemophilia A

4. Hereditary hemochromatosis

5. Hemolytic uremic syndrome 

Which of the following is an antiplatelet agent?

1. Warfarin

2. Bivalirudin

3. Apixaban

4. Clopidogrel

5. Heparin 

Which of the following is abnormal in patients with immune thrombocytopenic purpura?

1. Platelet count 

2. Prothrombin time (PT)

3. Partial thromboplastin time (PTT)

4. Hematocrit

5. Hemoglobin 

A 27-year-old female with no past medical history presents to the clinic with increasing fatigue and exertional dyspnea. She was concerned when she developed yellowing of the skin. 10 days ago, she was diagnosed with cellulitis and was placed on Cephalexin. On examination, pallor, jaundice, and splenomegaly are noted. Initial labs show decreased hemoglobin and hematocrit, increased reticulocytes, microspherocytes, and Coombs positivity (IgG). What is the most likely diagnosis?

1. G6PD deficiency

2. Paroxysmal nocturnal hemoglobinuria

3. Hereditary spherocytosis 

4. Warm autoimmune hemolytic anemia 

5. Folate deficiency 

Increased hemosiderin deposition in the liver is hallmark of which of the following?

1. Iron deficiency anemia 

2. Hereditary hemochromatosis

3. Wilsons disease 

4. Alpha-1-antitrypsin deficiency 

5. Coagulopathy of liver disease 

Which of the following is not a classic laboratory finding in patients with Polycythemia vera?

1. Increased hemoglobin

2. Increased hematocrit

3. Increased granulocytes 

4. Increased platelets

5. Increased serum erythropoietin levels 

Which of the following describes the main pathophysiologic mechanism for the development of thrombotic thrombocytopenia purpura?

1. IgM antibodies against RBC’s

2. Platelet activation by exotoxins 

3. Deficiency in ADAMTS13, a von Willebrand factor cleaving protease 

4. Autoantibodies against platelets 

5. Pathological activation of the coagulation cascade 

A 46-year old male presents to the clinic with fatigue and weakness. A CBC is performed, revealing decreased hemoglobin, decreased hematocrit, and an MCV of 70 fL. Serum ferritin iron, and reticulocyte counts are low and total iron binding capacity is increased. What is the most likely diagnosis?

1. B12 deficiency 

2. Thalassemia

3. Iron deficiency anemia

4. Folate deficiency

5. Anemia of chronic disease 

A 32-year-old female presents to the clinic with fatigue and decreased energy. She finds herself craving ice and clay. On examination, koilonychia is noted. Which of the following lab values would be increased in this patient?

1. Serum iron

2. Transferrin saturation 5

3. Serum ferritin

4. RBC distribution width 

5. Mean corpuscular volume 

A 15-year-old male presents to the ER with acute abdominal pain. He has a history of prior similar episodes. Examination of a peripheral smear reveals a normocytic anemia, target cells, and Howell-Jolly bodies. Which of the following is the most likely underlying etiology for his abdominal pain?

1. Henoch-Schonlein purpura

2. Sickle cell disease

3. G6PR deficiency 

4. Lead poisoning 

5. Iron deficiency anemia 

Which of the following is not a neurological complication in pediatric patients with sickle cell disease? 

1.  Transient ischemic attack 

2. Optic neuritis 

3. Ischemic stroke

4. Seizure disorder

5. Cognitive deficits 

A 19-year-old male with no past medical history is complaining of 2 episodes of epistaxis and ecchymosis. On physical exam, a petechial rash with no evidence of splenomegaly are noted. Initial labs show normal hemoglobin, hematocrit, a platelet count of 24,000 with an otherwise normal peripheral smear. PT and PTT are normal. Antiplatelet antibodies are positive. What is the initial management of choice?

1. Fresh frozen plasma

2. Plasmapheresis

3. Glucocorticoids 

4. Platelet transfusion

5. Splenectomy 

Which of the following medications is not associated with causing aplastic anemia? 

1. Chloramphenicol 

2. Diphenhydramine

3. Benzene

4. Phenytoin

5. Carbamazepine 

A 13-year-old boy presents to the ER with a painful erection. He states it happened about 4 hours ago and was not relieved with warm compresses, cool compresses, masturbation, or ejaculation. He was embarrassed about coming to the ER but became worried when it became painful. What is most likely in the patient's medical history?

1. Beta thalassemia

2. Alpha thalassemia

3. Sickle cell disease

4. Iron deficiency anemia

5. B12 deficiency 

Which of the following is not a classic finding of hemolytic anemia?

1. Decreased haptoglobin

2. Schistocytes

3. Increased lactase dehydrogenase (LDH)

4. Increased indirect bilirubin 

5. Decreased reticulocytes 

A 71-year-old male is complaining of bone pain and back pain, dyspnea, and fatigue for 2 months. The pain is associated with intermittent paresthesias to the anterior thigh. He denies urinary or bowel incontinence. On examination, there is localized vertebral tenderness with 5/5 motor strength. Initial labs reveal a normocytic normochromic anemia, hypercalcemia, and increased creatine. Which of the following is the next recommended step?

1. Hemoglobin electrophoresis

2. Plain radiographs of the spine 

3. Bone marrow aspiration

4. Bone scan

5. Prostate specific antigen 

A 60-year old female is being evaluated for decreased exercise tolerance and malaise. She denies any neurologic symptoms. Her diet consists mostly of meat and rice and she does not incorporate vegetables in her diet. Initial labs are positive for decreased platelets, leukopenia, increased MCV, decreased hemoglobin, normal methylmalonic acid and increased homocysteine levels. What is the most likely diagnosis?

1. Hemolytic anemia 

2. Thalassemia 

3. Iron deficiency anemia 

4. B12 deficiency 

5. Folate deficiency 

In patients with Waldenstrom macroglobulinemia, serum protein electrophoresis will show a monoclonal spike of which of the following?

1. IgM

2. IgD

3. IgA

4. IgE

5. IgG

A 5-year-old boy is being evaluated for fever, decreased activity, pallor, and easy bruising. On exam, pallor, splenomegaly, and hepatomegaly are noted. Initial CBC reveals a lymphocytosis with neutropenia, thrombocytopenia, and a normocytic normochromic anemia. What is the most appropriate next step?

1. High dose corticosteroids 

2. Hematopoietic stem cell transplant

3. Induction chemotherapy

4. Bone marrow biopsy

5. Serum protein electrophoresis 

Coarse blue granules evenly distributed within the RBC’s, known as basophilic stippling of the RBCs (), is hallmark of which of the following? PHOTO

1. Asbestosis 

2. Lead poisoning 

3. Carbon monoxide poisoning

4. Cyanide poisoning 

5. Cadmium poisoning 

Which of the following is the first-line management of Polycythemia vera without evidence of thrombosis?

1. RBC transfusion

2. Hyperbaric oxygen

3. Phlebotomy 

4. IV normal saline

5. Ruxolitnib 

A 12-year-old boy is complaining of left hip pain that is worse with ambulation. On examination, he is afebrile and there is decreased range of motion of the left hip. Initial radiographs are obtained. What is most likely in the patient’s history?

1. Hemophilia A

2. Hemophilia B

3. Sickle cell disease

4. Von Willebrand disease

5. Iron deficiency anemia 

Which of the following antibodies is primarily responsible for causing warm autoimmune hemolytic anemia?

1. IgA

2. IgE

3. IgM

4. IgD

5. IgG

Which of the following is the initial management of choice for acute hemarthrosis due to hemophilia B?

1. Cryoprecipitate

2. Recombinant factor VIII

3. Recombinant factor IX

4. Desmopressin 

5. Hydroxyurea 

Which of the following would most likely develop in patients whose diet consists almost entirely of meat?

1. Folate deficiency 

2. B12 deficiency 

3. Iron deficiency 

4. Lead poisoning  

5. Hemolytic anemia 

Which of the following is the initial management of choice for uncomplicated vaso-occlusive pain in patients with sickle cell disease?

1. IV fluids, oxygen, morphine 

2. Meperidine 

3. Ketorolac 

4. Transfusion therapy

5. IV immune globulin 

Which of the following is decreased in anemia of chronic disease?

1. Serum ferritin

2. Hepcidin

3. Total iron binding capacity

4. Red cell distribution width

5. Erythrocyte sedimentation rate 

Acute chest syndrome is a complication of which of the following?

1. Sickle cell disease 

2. G6PD deficiency 

3. Hemolytic uremic syndrome 

4. Thrombotic thrombocytopenic purpura 

5. Von Willebrand disease 

Patients with pernicious anemia require lifelong therapy with which of the following?

1. Iron

2. Niacin- B3

3. Pyridoxine- B6

4. Thiamine- B1

5. Cobalamin- B12 

A 37-year-old female is placed on methotrexate for psoriatic arthritis. She develops stomatitis, fatigue, and megaloblastic anemia with hyper-segmented neutrophils. Disturbance of which of the following is the most likely cause of the anemia? 

1. Folate

2. Cobalamin

3. Thiamine 

4. Riboflavin

5. Iron 

Which of the following is usually avoided in patients with sickle cell disease presenting with acute vaso-occlusive pain?

1. Ketamine

2. Ketorolac

3. Hydromorphone

4. Morphine

5. Fentanyl 

Which of the following medications is not associated with causing aplastic anemia?

1. Acetaminophen

2. Carbamazepine 

3. Chloramphenicol 

4. Phenytoin

5. Quinine 

Direct Coombs positivity is hallmark for which of the following?

1. Immune thrombocytopenic purpura 

2. Hereditary spherocytosis 

3. Warm autoimmune hemolytic anemia 

4. Thalassemia 

5. Sickle cell disease

Which of the following disease is characterized by the pentad of thrombocytopenia, hemolytic anemia, neurologic symptoms, renal involvement, and fever? 

1. Hemophilia A

2. Von Willebrand disease

3. Waldenstrom macroglobulinemia 

4. Hemolytic uremic syndrome

5. Thrombotic thrombocytopenic purpura 

Which of the following is classically decreased in patients with polycythemia vera? 

1. Erythropoietin levels

2. Leukocyte alkaline phosphatase 

3. Hematocrit

4. Platelets

5. Granulocytes 

Ristocetin cofactor activity is a screening test used for which of the following disorders?

1. Immune thrombocytopenic purpura

2. Thrombotic thrombocytopenic purpura

3. Von Willebrand disease

4. Henoch-Schonlein purpura 

5. Hemolytic uremic syndrome 

Supplementation of which of the following is essential in the long-term management of sickle cell disease?

1. Iron

2. Riboflavin

3. Pyridoxine

4. Folate

5. Ascorbic acid 

What is the most common heavy metal toxicity seen in children?

1. Iron 

2. Cadmium

3. Arsenic

4. Chromium

5. Lead 

Which of the following is the most important component in the management of anemia of chronic disease?

1. Folate supplementation

2. Iron supplementation

3. Vitamin C supplementation

4. Treatment of the underlying chronic disease

5. Erythropoietin-alpha

In children with Sickle cell disease, which of the following vaccine has the greatest impact in reducing morbidity and mortality during early childhood?

1. Varicella vaccine

2. Hepatitis A vaccine

3. Hemophilus influenzae vaccine

4. Rabies vaccine

5. Hepatitis B vaccine 

A 30-year-old male receives monthly injections of B12 for pernicious anemia. He is concerned because he just lost his job and is not sure if he can continue to seek medical care. Which of the following would most likely occur if he does not continue B12 therapy?

1. Symmetric paresthesia’s and ataxia

2. Koilonychia, pica and pagophagia

3. Jaundice and clay-colored stools

4. Painless enlargement of the gallbladder 

Which of the following values is not consistent with a pure iron deficiency anemia?

1. Increased reticulocyte count

2. Increased TIBC

3. Decreased ferritin

4. Decreased mean corpuscular volume (MCV)

5. Increased red cell distribution width (RDW)

What is the initial diagnostic study of choice in a patient with microcytic hypochromic anemia, target cells, Heinz bodies, increased ferritin levels, and normal serum iron?

1. Hemoglobin electrophoresis 

2. Methylmalonic acid level

3. Serum B12 level

4. Serum folate level

5. Bone marrow biopsy 

Severe deficiency in iron leads to which of the following?

1. Hemolytic anemia

2. Normocytic anemia

3. Macrocytic anemia

4. Microcytic anemia

5. Macro-ovalocytotsis 

What is the definitive diagnostic test for suspected hemochromatosis?

1. CBC

2. Serum iron studies

3. Liver biopsy

4. Electrophoresis 

5. Bone marrow biopsy 

Which of the following complications of sickle cell disease is most likely to occur during infancy?

1. Avascular necrosis of the hip

2. Acute chest syndrome

3. Stroke

4. Priapism

5. Dactylitis 

In evaluation of a peripheral smear, a normocytic normochromic anemia is seen with the presence of target cells, increased reticulocytes, and Howell-Jolly bodies. Which of the following is the recommended next step?

1. Hemoglobin electrophoresis 

2. Bone scan

3. Bone marrow aspiration

4. Osmotic fragility test

5. DNA analysis 

A 12-year-old boy with a history of sickle cell disease presents to the ER with left hip pain worse with ambulation. He denies fever or child. On exam, he is afebrile and there is decreased range of motion of the left hip. Initial radiographs are negative. What is the most appropriate next step?

1. CT scan of the hip

2. MRI of the hip

3. Analgesics and orthopedic follow up

4. Prompt return to regular activities 

5. Partial weight bearing exercise 

A boy is being evaluated for abdominal pain, constipation, increasing lethargy, and a new-onset foot drop that started after they began to renovate their house. His parents are concerned that he may have been exposed to mold over the last 8 months with the renovation. A radiograph of his knee is performed () what is the most likely cause of his symptoms? SEE PHOTO

1. Mold exposure

2. Lead poisoning 

3. Cadmium exposure

4. Folate deficiency 

5. Asbestos 

A 67-year old male presents with bone pain and symptoms of anemia. A skeletal survey shows multiple radiolucent “punched out” lesions. Which of the following would most likely also be seen?

1. Hypernatremia

2. Hyponatremia 

3. Hypocalcemia

4. Hypokalemia

5. Hypercalcemia 

A 15-year-old male presents to the ER with fever, cough, and chest pain. E had prior EPISODES 2,3, and 7 months ago that required admission for IV hydration and pain control. A peripheral smear is positive for Howell-Jolly bodies. What is the most likely underlying disorder?

1. Severe B12 deficiency 

2. Sickle cell disease 

3. Alpha thalassemia minor

4. Beta thalassemia minor

5. Autoimmune hemolytic anemia 

A 55-year-old male from Northern Europe is being evaluated for a 7-month hx of generalized fatigue, joint pain, decreased libido and tanning of his skin despite no sun exposure. He has a family history of type II Diabetes mellitus and Cirrhosis. On exam, his skin is hyperpigmented. Initial labs are positive for normocytic normochromic anemia. What is the initial test of choice?

1. Serum B12 levels

2. Serum folate levels

3. Serum protein electrophoresis

4. Liver biopsy

5. Iron studies 

After iron supplementation in patients with iron deficiency anemia, how soon will there be an increase in reticulocytes?

1. 5-10 days

2. 6-8 weeks

3. 1-3 months

4. 6-12 months

5. 2 years 

Which of the following drugs is used to improve survival and reduce the frequency and severity of acute pain episodes in patients with sickle cell disease?

1. Hydromorphone

2. Hydroxyzine

3. Hydroxychloroquine

4. Hydroxyurea

5. Hydrocodone 

A 55-year-old homeless male with a hx of pernicious anemia and chronic alcoholism has been lost to follow up for years. He presents with symptoms of dementia. Which of the following would his symptoms most likely resemble?

1. Vascular dementia

2. Frontotemporal dementia

3. Huntington disease

4. Creutzfeldt-Jakob disease

5. Alzheimer dementia 

A 6-month-old African American infant being bottle-fed is noted to have pallor and is feeding less. A CBC is performed, showing decreased hemoglobin and hematocrit, a normocytic normochromic anemia and an increased reticulocyte count. Peripheral smear shows target cells. What is the best next step?

1. Initiate B13 supplementation

2. Hemoglobin electrophoresis 

3. Initiate folate supplementation 

4. Bone marrow biopsy

5. Initiate iron supplementation 

Which of the following is not a classic feature of hemolytic uremic syndrome?

1. Oliguria

2. Bloody diarrhea

3. Hematuria

4. Neurologic symptoms 

5. Abdominal pain 

What is the classic presentation of Beta thalassemia major (Cooleys anemia) 

1. No symptoms 

2. Mild anemia with marked microcytosis and hypochromia 

3. Moderate to severe anemia, jaundice, frontal bossing and hepatosplenomegaly 

4. Pica, pagophagia and koilonychia 

Which of the following is hallmark of folate deficiency?

1. Hypersegmented neutrophils

2. Schistocytes 

3. Thrombocytosis 

4. Ringed sideroblasts

5. Reed-Sternberg cells 

Koilonychia (spooning of the nails) is hallmark of which of the following?

1. Anemia of chronic disease

2. Folate deficiency 

3. B12 deficiency 

4. Thalassemia

5. Iron deficiency anemia 

Which of the following people is at least risk for the development of iron deficiency anemia?

1. Infant being fed cows milk

2. 23-year-old female at 20 weeks gestation

3. 35-year-old male with celiac disease

4. 30-year-old male with history of asthma 

5. 30-year-old female with a history of menorrhagia 

A 34-year-old female with a history of systemic lupus erythematosus develops fatigue and SOB, especially with exertion. On exam, splenomegaly and jaundice are noted. Initial labs show mildly decreased hemoglobin and hematocrit, increased reticulocytes, microspherocytosis and Direct Coombs positivity for IgG and C3. What is the initial management of choice? Check out the anemia PP slides 160-163

1. RBC transfusion

2. Splenectomy

3. Prednisone

4. Rituximab

5. Cyclophosphamide 

A 6-year-old child is brought to the ER with nausea and multiple episodes of vomiting. Part of the workup reveals a serum lead level of 80 mcg/dL. What is the most appropriate next step?

1. Deferoxamine

2. Observation and follow-up lead levels in 1 month

3. N-acetylcysteine

4. Chelation therapy 

5. Protamine sulfate 

Which of the following is not a classic finding of B12 deficiency?

1. Ataxia 

2. Symmetric peripheral neuropathy

3. Hypersegmented neutrophils

4. Microcytosis 

5. Abnormal DNA synthesis 

Which of the following is classic for anemia of chronic disease?

1. Normal RDW, low MCV, increased reticulocytes and Heinz bodies

2. Schistocytes, normal MCV, target cells, Howell-Jolly bodies

3. High RDW, low MCV, hypochromia, decreased ferritin

4. High RDW, high MCV, increased methylmalonic acid 

5. Normal to high RDW, normal MCV, increased ferritin 

During a well visit, a 1-year-old female is found on routine blood testing to have mild microcytic anemia. A hemoglobin electrophoresis shows an increase in hemoglobin A2 and hemoglobin F. What is the most likely diagnosis?

1. Iron deficiency anemia 

2. Beta thalassemia trait

3. Lead toxicity 

4. B12 deficiency 

5. Alpha thalassemia trait 

Which of the following would be most useful to increase absorption of iron?

1. Antacids

2. Orange juice

3. Milk

4. Yogurt

5. Ice cream 

Plummer-Vinson syndrome is characterized by?

1. Primary ciliary dyskinesia 

2. Iron deficiency anemia + dysphagia + cervical esophageal web

3. Signs and symptoms due to cortisol excess

4. Rheumatoid arthritis + Coal workers pneumoconiosis

5. Autoimmune hemolytic anemia + idiopathic thrombocytopenic purpura 

Trimethoprim-sulfamethoxazole is classically associated with which of the following?

1. Iron deficiency anemia 

2. Sideroblastic anemia

3. Anemia of chronic disease

4. B12 deficiency 

5. Folate deficiency 

What is the most common cause of iron deficiency anemia worldwide?

1. Diet

2. Achlorhydria 

3. Celiac disease

4. SLC11A2 mutation

5. Reduced iron absorption 

A 35-year-old vegetarian with mild iron deficiency anemia was prescribed oral ferrous sulfate daily and then switched to every other day. She admits to non-compliance with her iron regimen because the “iron pull gives me abdominal pain and gas”. Which of the following would you recommend initially?

1. Take the iron pill with 3 glasses of milk

2. Take the iron pill with ice cream to coat the stomach 

3. Take the iron pill daily to increase tolerance

4. Take the iron pill with antacids 

5. Trials of switching to liquid polysaccharide iron complex 

A 66-year-old male is complaining of bone pain and back pain, dyspnea, and fatigue for 2 months. Initial labs reveal a normocytic normochromic anemia, hypercalcemia, and increased creatine. Which of the following is the next recommended step?

1. Serum protein electrophoresis 

2. Bone marrow aspiration

3. Bone scan

4. Prostate specific antigen

5. Hemoglobin electrophoresis 

A 7-year-old boy is being evaluated for intermittent abdominal cramps, constipation, recurrent headaches, and fatigue. His mother states he was previously healthy until they moved into her grandmothers old house to take care of her. Initial labs reveal a microcytic hypochromic anemia with basophilic stippling of the red blood cells. Based on the most likely diagnosis, which of the following is the most appropriate next step?

1. Bone marrow biopsy

2. Hemoglobin electrophoresis

3. Serum B12 levels

4. Serum folate levels

5. Serum lead levels 

A 47-year-old male with a hx of atrophic gastritis and achlorhydria presents to the clinic with numbness to his fingers and toes. On exam, there is decreased pinprick sensation and proprioception of the toes. Initial labs reveal an MCV of 120 fL and decreased hemoglobin. Peripheral smear reveals macro-ovalocytes and hypersegmented neutrophils. What is the most likely diagnosis?

1. Iron deficiency anemia 

2. B12 deficiency 

3. Anemia of chronic disease

4. Thalassemia

5. Folate deficiency 

A 7-month-old previously healthy infant of Mediterranean decent presents with new-onset of failure to thrive. On exam, prominent facial features, jaundice, and splenomegaly are noted. Initial labs reveal a hemoglobin of 6.5 g/dL. Which of the following would most likely be seen?

1. Hypersegmented neutrophils 

2. Decreased serum ferritin

3. Increased red cell distribution width

4. Megalo-ovalocytes

5. Microcytosis and hypochromia 

A 50-year-old female with a hx of gastric bypass surgery is complaining of numbness and a “tight” sensation affecting her fingers and toes. On exam, pallor, glossitis, and deficits with proprioception and vibratory sensation of the toes are noted. Initial labs reveal macrocytic anemia with macro-ovalocytes and hypersegmented neutrophils. What is the most likely diagnosis?

1. B12 deficiency

2. Anemia of chronic disease

3. Thalassemia 

4. Folate deficiency 

5. Iron deficiency anemia 

Which of the following is decreased in patients with Hereditary hemochromatosis?

1. Transferrin iron saturation %

2. Serum iron

3. Ferritin

4. Total iron binding capacity

5. Hemosiderin 

A 45-year-old male with a history of Rheumatoid arthritis presents to the clinic with decreased exercise tolerance, weakness, and fatigue. On exam, pallor is noted. A CBC is performed, showing a normocytic normochromic anemia with decreased reticulocyte count, decreased serum iron, increased serum ferritin, and decreased TIBC. What is the most likely diagnosis?

1. Anemia of chronic disease

2. Iron deficiency anemia 

3. Thalassemia 

4. B12 deficiency 

5. Folate deficiency 

Which of the following is not a classic laboratory finding in patients with aplastic anemia?

1. Decreased hemoglobin 

2. Decreased reticulocyte count

3. Leukopenia

4. Hypoplastic bone marrow with fatty infiltrates

5. Thrombocytosis 

Which of the following is not a classic finding of sickle cell disease on peripheral smear?

1. Target cells

2. Howell-Jolly bodies

3. Reticulocytosis  

4. Hypersegmented neutrophils

5. Normal mean corpuscular volume (MCV)

Which of the following is used to treat lead toxicity?

1. Glucagon

2. Succimer 

3. Deferasirox

4. N-acetylcysteine

5. Deferoxamine 

Which of the following vitamins naturally occur primarily in animal sources, such as meat, eggs, and poultry?

1. Ascorbic acid

2. Thiamine

3. Pyroxidine

4. Cobalamin

5. Folate 

Wat is classic type of anemia in sickle cell disease?

1. Megaloblastic 

2. Microcytic, hypochromic

3. Macrocytic 

4. Sideroblastic

5. Normocytic normochromic 

B. Bone marrow aspiration

E. Factor V Leiden mutation 

D. Macrocytic

E. analgesics 

C. Chronic transfusion therapy 

C. IV fluids, electrolyte replacement and admission for supportive therapy 

B. Type II (cytotoxic)

B. Sickle cell disease 

D. Glycoprotein GP1b receptor on platelets 

B. Iron deficiency anemia + dysphagia + cervical esophageal web

B 25%

D. hereditary hemochromatosis 

D. Clopidogrel 

A. platelet count 

D. warm autoimmune hemolytic anemia 

B. hereditary hemochromatosis 

E. increased serum erythropoietin levels 

C. Deficiency in ADAMTS13, a Von Willebrand factor cleaving protease 

C. iron deficiency anemia 

D. RBC distribution width 

B. Sickle cell disease 

B. Optic neuritis 

C. Glucocorticoids

B. Diphenhydramine 

C. sickle cell disease

E. decreased reticulocytes 

B. plain radiograph of the spine 

E. folate deficiency 

A. IgM

D. bone marrow biopsy

B. lead poisoning

C phlebotomy 

C. sickle cell disease

E. IgG

C. recombinant factor IX

A. folate deficiency 

A. IV fluids, oxygen, morphine

C. total iron binding capacity

A. sickle cell disease

E. cobalamin—B12

A. folate 

B. Ketorolac 

A. acetaminophen 

C warm autoimmune hemolytic anemia 

E. thrombotic thrombocytopenic purpura 

A. Erythropoietin levels 

C. von Willebrand disease 

D. folate 

E. lead 

D. treatment of the underlying disease 

C. Hemophilus influenzae vaccine

A. symmetric paresthesia’s and ataxia 

A. increased reticulocyte count 

A. hemoglobin electrophoresis 

D. Microcytic anemia

C. liver biopsy 

E. Dactylitis 

A. hemoglobin electrophoresis 

B. MRI of the hip

B. lead poisoning 

E. hypercalcemia

B. sickle cell disease 

E. iron studies

A. 5-10 days

D. Hydroxyurea

E. Alzheimer dementia 

B. hemoglobin electrophoresis 

C. Hematuria 

C. moderate to severe anemia, jaundice, frontal bossing and hepatosplenomegaly 

A. hypersegmented neutrophils 

E. iron deficiency anemia 

D. 30-year-old mal with history of asthma 

C. Prednisone 

D. Chelation therapy

D. Microcytosis 

E. normal to high RDW, normal MCV, increased ferritin

B. beta thalassemia trait

B. Orange juice

B. iron deficiency anemia + dysphagia + cervical esophageal web

E. folate deficiency 

A. diet 

E. trials of switching to liquid polysaccharide iron complex

A serum protein electrophoresis 

E. serum lead levels

B B12 deficiency 

E. microcytosis and hypochromia 

A. B12 deficiency 

D. total iron binding capacity 

A. anemia of chronic disease 

E. thrombocytosis 

D. hypersegmented neutrophils 

B. Succimer 

D. Cobalamin

E. Normocytic normochromic