Anemia, the commonest blood disorder still poorly understood, is prevalent from newborn, to adolescents, in pregnancy, and till menopause! A small quiz may give some answers.

  • Q1. Which of the following is NOT a cause of microcytic anemia?

    1. Thalassemia

    2. Anemia of chronic disease

    3. Iron deficiency anemia

    4. Pancytopenia

    5. Lead poisoning

  • Q2. The lab reports for a patient with low mean cell volume show high serum ferritin and low total iron binding capacity. What is the most likely cause for this patient's anemia?

    1. Fe deficiency

    2. Anemia secondary to inflammation

    3. Thalassemia

    4. Hemoglobinopathy

  • Q3. Fe is absorbed in the

    1. Stomach

    2. Duodenum

    3. Jejunum

    4. Ileum

  • Q4. Where is most nonheme iron found in the body?

    1. Bound to IF

    2. Bound to transferrin

    3. Free in plasma

    4. Stored in liver

  • Q5. Select the following that enhance Fe absorption (select all that apply)

    1. Citric acid

    2. Polyphenols (tea)

    3. Phytate (bran)

    4. Calcium

    5. Ascorbic acid

  •  Q6. What is the most important test for Fe stores?

    1. Serum iron

    2. TIBC

    3. Serum ferritin

  •  Q7. Which of the following is not an etiology of Fe deficiency anemia?

    1. Chronic blood loss

    2. Increased requirement

    3. Infection

    4. Malabsorption

    5. Decreased intake

  •  Q8. TIBC increases in iron deficiency anemia because

    1. Inflammatory response to deficiency

    2. Compensation by other factors

    3. Ability to absorb increases

  •  Q9. Pica, a clinical presentation for Fe deficiency anemia, is

    1. Itchiness

    2. ED

    3. Desire to eat weird things

    4. A small woodland creature

  • Q10. Which lab investigations would you order if you suspect Fe deficiency anemia? (check all that apply)

    1. CBC

    2. Blood smear

    3. Serum iron

    4. Serum ferritin

    5. TIBC

    6. All of the above

  • Q11. Where is beta-thalassemia most common? (check all that apply)

    1. West Africa

    2. Mediterranean

    3. Arabian Peninsula

    4. South East Asia

    5. Canada

  • Q12. What is the difference between beta-thalassemia major and beta-thalassemia minor?

    1. Homozygous vs heterozygous

    2. Acute vs chronic

    3. Legal drinking age

  • Q13. Heinz bodies are made of:

    1. Excess gamma chains

    2. Excess alpha chains

    3. Excess beta chains

    4. Excess ketchup

  • Q14. Beta-thalassemia, unlike alpha-thalassemia, presents at approximately 6 months of age.

    1. True

    2. False

  • Q15. Which would you expect to see on a blood smear for beta-thalassemia? (select all that apply)

    1. Heinz bodies

    2. Multinucleated neutrophils

    3. Target cells

    4. Hypochromic microcytic cells

    5. Hyperchromic microcytic cells

  • Q16. What is the treatment for beta-thalassemia minor?

    1. Blood transfusions

    2. Iron chelation

    3. Bone marrow transplant

    4. None of the above

  • Q17. Decreased or stopped production of alpha-globin chains results in HbH (4 gamma chains together) and Hb Barts (4 beta chains together)

    1. True

    2. False

  • Q18. On a CBC for alpha-thalassemia, you would see anemia and reticulocytosis. On the blood smear, you would see Heinz bodies, hypochromic microcytic cells, and occasional target cells. Select the others that you would see increase:

    1. LDH

    2. Unconjugated bilirubin

    3. Conjugated bilirubin

    4. Urine urobilinogen

    5. Urine hemosiderin

  • Q19. Aplastic anemia can be acquired (more common) and inherited. What are some of the ways it can be acquired?

    1. Postviral infection

    2. Pregnancy

    3. Ionizing radiation

    4. Drugs and chemicals

    5. Idiopathic

    6. All of above

  • Q20. Aside from the gradual onset signs of anemia, what other clinical presentations would you see with aplastic anemia?

    1. Koilonychias, “spoon nails”

    2. Associated thrombocytopenia, e.g., history of bleeding from the gums

    3. Neutropenia, e.g., repeated bacterial infections

    4. Purpura

    5. Pica

  • Q21. How would you diagnose aplastic anemia?

    1. Blood smear

    2. Bone marrow biopsy

    3. Spleen biopsy

    4. CBC

    5. Liver biopsy

  • Q22. Select treatment options for aplastic anemia

    1. IV equine ATG

    2. Bone marrow transplant

    3. Splenectomy

    4. Immune suppression

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Maninder Ahuja

Vice President FOGSI (2013—2014)

Answers: 1(d), 2(b), 3(b), 4(b), 5(a, e), 6(c), 7(c), 8(c), 9(c), 10(f), 11(b, c, d), 12(a), 13(b), 14(a), 15(a, c, d), 16(d), 17(b), 18(a, b, d, e), 19(f), 20(b, c, d), 21(b), 22(a, b, d)