Anemia: Readiness Assurance Test

1. A 26 year old female presents to your office complaining of six months of fatigue.
During the interview, she states that she has been having heavy periods that have
not changed recently. She also has a family history of Hashimoto’s disease. You
order laboratory testing to investigate whether she has anemia. In the meantime,
you decide to start the patient on iron supplementation and refer her to Ob/Gyn for
her menorrhagia. When her results return to your office the following day, her CBC
shows a hemoglobin of 10.2 with an MCV of 82. Her ferritin is 75 and her
reticulocyte count is low. Her TSH is 4.3. You see her back in one month for a
follow-up visit. If her anemia is caused primarily by iron deficiency, repeat laboratory
work at this time is most likely to show which of the following:

a. Increased Hemoglobin-
b. Decreased MCV
c. Low Reticulocyte Counts
d. No changes
e. High Ferritin

2. A 75 year old man presents to your office after a recent lab test showed a
hemoglobin of 9.5, MCV 85, and ferritin of 360. The patient has a number of
medical problems. Which of the following on his list of problems is most likely to be
causing his anemia?

a. Benign Prostatic Hyperplasia

b. Coronary artery disease
c. Sarcoidosis-
d. Migraine Headache
e. Osteoarthritis

3. A 21 year old man with sickle cell anemia presents to the ER and is admitted for
acute chest syndrome. Which of the following findings are most consistent with the
definition of acute chest syndrome?

a. Fever, chest pain, new pulmonary infiltrate-

b. Fever, cough, hemoptysis
c. Severe chest pain associated with abdominal and back and extremity pain
d. Pulmonary hypertension and right heart failure
e. Sudden decrease in hemoglobin and increased reticulocyte count

4. A 24 year-old woman presents to your office for follow up of a routine life

insurance-related physical exam which included a complete blood count (CBC). The
CBC revealed a hemoglobin of 11 g/dL and an MCV of 101. Which of the following is
most likely to be the cause of her macrocytic anemia?

a. Anemia of chronic disease

b. Hypothyroidism-
 c. Iron deficiency
d. Lead
e. Thalassemia

5. An 18 year old man presents to the clinic for his first annual physical after
immigrating from Sicily. During his initial evaluation, a CBC showed a hemoglobin of
10.2 with an MCV of 68. He has a family history of anemia but otherwise feels well.
Which of the following is the best test to further evaluate his anemia?

a. Bone marrow biopsy

b. Erythropoietin level
c. Hemoglobin electrophoresis
d. Total bilirubin-
e. TSH

6. A 75 year old female presents to your office complaining of fatigue and tingling in
her fingers and toes. Her initial CBC shows a hemoglobin of 10 with an MCV of 105.
Which of the following sets of additional laboratory data is most likely to represent a
presentation of B12 deficiency as a cause of the patient’s anemia (normal B12 level
is greater than 200)?

a. Low WBC and platelets, B12 level 100 pg/mL, homocysteine elevated,
methylmalonic acid elevated-
b. Normal WBC and platelets, B12 level 100 pg/mL, homocysteine
decreased, methylmalonic acid elevated
c. Normal WBC and platelets, B12 level 100 pg/mL, homocysteine
decreased, methylmalonic acid normal
d. Low WBC and platelets, B12 level 400 pg/mL, homocysteine elevated,
methylmalonic acid elevated
e. Normal WBC and platelets, B12 level 100 pg/mL, homocysteine elevated,
methylmalonic acid normal

7. A 45 year old man with a history of diverticulosis presents to the ER with

shortness of breath and fatigue after having 5 large bloody bowel movements over
the past two days. In preparing to perform a physical exam on the patient, the
clinical sign or symptom with the highest predictive value for diagnosing anemia is:

a. Conjunctival rim pallor-

b. Dyspnea
c. Fatigue
d. Jaundice
e. Palmar crease pallor
8. A 35 year old man with HIV presents to the ER complaining of weakness,
shortness of breath, dark urine, and fever. You obtain a CBC as part of your initial
evaluation and the hemoglobin returns at 5.9. You immediately order additional
tests including a reticulotye count, haptoglobin, LDH, peripheral smear, and PT/PTT.
Which of the following results would be most consistent with a diagnosis of
Thrombotic Thrombocytopenic Purpura?
a. Decreased reticulocyte count
b. Elevated haptoglobin
c. Elevated PT and PTT
d. Positive Coomb’s Direct Antibody Test
e. Schistocytes on peripheral smear-