Question 1

Which of following are typical laboratory results for ACI?&#10;A)decreased ferritin and decreased bone marrow Prussian blue staining&#10;B)low serum iron and high TIBC&#10;C)low serum iron and low TIBC&#10;D)increased transferrin saturation and decreased FEP

Accepted Answer

Both serum iron and TIBC are low in ACI.Ferritin is normal to increased,and Prussian blue staining reveals normal to increased storage iron.However,the number of sideroblasts and siderocytes is decreased to absent because iron cannot be moved to developing red cells.FEP is increased,just as it is in iron deficiency anemia.

Question 2

Which of the following red cell inclusions is or are often found in lead poisoning?&#10;A)Howell-Jolly bodies&#10;B)basophilic stippling&#10;C)Heinz bodies&#10;D)Cabot rings

Accepted Answer

Basophilic stippling,sometimes quite coarse,is characteristic of lead poisoning.Lead interferes with the breakdown of pyrimidine 5¢-nucleotides,which in turn are believed to retard the breakdown of ribosomal ribonucleic acid (RNA),thus leading to stippling.

Question 3

Why is too much iron dangerous?&#10;A)Transferrin, which carries iron, causes cellular swelling and lysis.&#10;B)The oxygen carried by excess iron oxidizes neurologic cells.&#10;C)Iron's breakdown products cause excretion of vitamins C and E.&#10;D)Free radicals and superoxide formed from ferrous iron plus oxygen damage cell membranes.

Accepted Answer

When iron exceeds storage capacity,ferrous iron accumulates in cells.Ferrous iron is easily oxidized and in so doing generates superoxide and other free radicals,which are very damaging to cell membranes,mitochondria,and other cell organelles.Cell death and eventual possible organ failure are consequences.

Question 4

Which of the following characterizes stage 1 iron deficiency?
AnemiaMCVFerritin

A)Present Decreased Decreased
B)Present Normal Normal
C)Absent Normal Decreased
D)Absent Decreased Normal

Accepted Answer

In early stage 1 iron deficiency,the red cell mass in circulation is unaffected,so anemia is not present and the MCV is normal.However,iron stores are being depleted,so ferritin is decreased.

Question 5

Which of the following is decreased in patients with hereditary hemochromatosis?&#10;A)albumin&#10;B)serum iron&#10;C)transferrin saturation&#10;D)ferritin

Accepted Answer

Liver damage and disease is a consequence of hereditary hemochromatosis;albumin is synthesized in the liver,and with liver damage its concentration decreases.Serum iron,transferrin saturation,and ferritin are all increased.

Question 6

Most of the clinical findings in the porphyrias are related to&#10;A)accumulated porphyrin compounds in tissue.&#10;B)anemia.&#10;C)reduction in heme production.&#10;D)iron being unavailable.

Accepted Answer

In the porphyrias (generally used to refer to the inherited forms as opposed to acquired),an enzyme is missing in the protoporphyrin IX synthesis pathway.When an enzyme is missing,the products from earlier stages in the pathway accumulate in the blood.Some of these are excreted,but they also deposit in body tissues,contributing to the clinical picture.

Question 7

Which of the following groups is least likely to develop iron deficiency?&#10;A)infants&#10;B)young men&#10;C)teenage girls&#10;D)adult premenopausal women

Accepted Answer

Young men can easily absorb enough iron to replace the small amount they lose each day and,in fact,can absorb slightly more than needed so that their stores remain adequate.Infants,as they grow,have an expanding erythron requiring more iron.Teenage girls and adult premenopausal women lose iron during their menstrual cycle,and may not absorb adequate amounts of iron to replace all that is lost.

Question 8

Transfusion-related hemochromatosis is seen in patients who&#10;A)had an adverse reaction to a blood transfusion.&#10;B)received the wrong type of blood.&#10;C)had lifelong repeated red cell transfusions.&#10;D)received a transfusion from a relative.

Accepted Answer

When patients with chronic severe anemias are maintained with red cell transfusions,the iron in the transfused red cells adds to any iron that is being absorbed normally.No mechanism exists to rid the body of iron.Over years,this excess iron builds up and acquired hemochromatosis develops.Red cell transfusions are thus a "double-edged sword" for these patients.On one hand,they improve the quality of life and perhaps even save it for the patient;on the other,the eventual consequence after years of transfusions is acquired hemochromatosis.

Question 9

What would be the likely findings if a bone marrow aspiration were performed in a complicated case of iron deficiency anemia?&#10;A)increased myeloid-to-erythroid (M:E) ratio and increased staining with Prussian blue&#10;B)shaggy polychromatophilic normoblasts and no staining with Prussian blue&#10;C)polychromatophilic normoblasts with copious pink cytoplasm and no staining with Prussian blue&#10;D)increased M:E ratio and increased ringed sideroblasts

Accepted Answer

Shaggy polychromatophilic normoblasts are seen because of the asynchronous maturation of developing red cells,with the cytoplasm lagging behind that of the nucleus.Prussian blue is an iron-specific stain;in iron deficiency anemia,iron stores are absent,and sideroblasts and siderocytes are markedly decreased to absent.The M:E ratio is increased late in iron deficiency because fewer red cell precursors exist in the marrow,but no staining with Prussian blue occurs.

Question 10

Where is most of the iron in the body found?&#10;A)attached to hemoglobin in the red blood cells (RBCs)&#10;B)stored in macrophages in the bone marrow&#10;C)attached to transferrin&#10;D)myoglobin

Accepted Answer

Approximately 65% of total body iron is found in hemoglobin.Another 25% is stored as ferritin or hemosiderin,and about 10% is divided among muscles,plasma,cytochrome of cells,and various iron-containing enzymes of cells.

Question 11

What parameter of the routine complete blood count (CBC)is a sensitive indicator of preclinical iron deficiency?&#10;A)red blood cell distribution width (RDW)&#10;B)hematocrit&#10;C)mean cell hemoglobin (MCH)&#10;D)red blood count

Accepted Answer

The answer of What parameter of the routine complete blood...

Question 12

Which test will rise first after successful treatment for iron deficiency?&#10;A)reticulocyte count&#10;B)ferritin&#10;C)MCV&#10;D)hemoglobin

Accepted Answer

The answer of Which test will rise first after successful...

Question 13

How does lead exposure and the porphyrias cause anemia?&#10;A)cause destruction of red cells&#10;B)chelate iron from the body&#10;C)impair iron absorption&#10;D)interfere with heme production

Accepted Answer

The answer of How does lead exposure and the porphyrias...

Question 14

Which of the following results is or are typical in stage 3 iron deficiency anemia?&#10;A)elevated reticulocyte percentage&#10;B)thrombocytopenia&#10;C)macrocytic red cells&#10;D)low mean cell volume (MCV), MCH, and mean cell hemoglobin concentration (MCHC)

Accepted Answer

The answer of Which of the following results is or...

Question 15

What is the mechanism for ACI?&#10;A)Acute phase reactants impair iron mobilization.&#10;B)Inflammation and infections slow heme development.&#10;C)Cytokines prevent iron incorporation into protoporphyrin.&#10;D)Bone marrow iron stores are depleted by acute phase reactants.

Accepted Answer

The answer of What is the mechanism for ACI?&#10;A)Acute phase...

Question 16

What is most likely if a 10-month-old child fed only cow's milk has the following results?
· Serum iron decreased
· Total iron-binding capacity (TIBC)increased
· Ferritin decreased

A)lead poisoning
B)chronic disease
C)iron deficiency from increased need and inadequate diet
D)iron deficiency from chronic blood loss

Accepted Answer

The answer of What is most likely if a 10-month-old...

Question 17

Which group of patients is most likely to develop iron deficiency from increased need?&#10;A)young men&#10;B)infants and young children&#10;C)postmenopausal women&#10;D)middle-aged men

Accepted Answer

The answer of Which group of patients is most likely...

Question 18

Which of the following is the best test to distinguish iron deficiency anemia from ACI?&#10;A)serum iron&#10;B)hemoglobin&#10;C)free erythrocyte protoporphyrin (FEP)&#10;D)ferritin

Accepted Answer

The answer of Which of the following is the best...

Question 19

Lack of accessible iron is the mechanism for iron deficiency in which of the following?&#10;A)hemochromatosis&#10;B)hemosiderosis&#10;C)lead poisoning&#10;D)anemia of chronic inflammation (ACI)

Accepted Answer

The answer of Lack of accessible iron is the mechanism...

Question 20

Which of the following promotes increased iron absorption?&#10;A)repeated phlebotomy&#10;B)eating iron-rich foods along with those high in ascorbic acid&#10;C)desferrioxamine&#10;D)vegetarian diet

Accepted Answer

The answer of Which of the following promotes increased iron...

Question 21

Ringed sideroblasts are a reflection of iron-laden&#10;A)mitochondria.&#10;B)Golgi complex.&#10;C)ribosomes.&#10;D)rough endoplasmic reticulum.

Accepted Answer

The answer of Ringed sideroblasts are a reflection of iron-laden&#10;A)mitochondria.&#10;B)Golgi...

Question 22

Why is lead poisoning of particular concern in children?&#10;A)Severe anemia may develop.&#10;B)Impaired mental development may occur.&#10;C)Secondary iron deficiency may develop.&#10;D)FEP may accumulate.

Accepted Answer

The answer of Why is lead poisoning of particular concern...

Question 23

All of the following are true about hepcidin except that&#10;A)it is an acute phase protein.&#10;B)it is a hormone.&#10;C)it decreases in response to increased ferritin.&#10;D)it increases in response to increased iron stores.

Accepted Answer

The answer of All of the following are true about...

Question 24

Which of the following is true of stage 3 iron deficiency?&#10;A)Serum transferrin receptors are decreased.&#10;B)FEP is increased.&#10;C)The number of sideroblasts is normal.&#10;D)The red cell count is increased, whereas the hematocrit is decreased.

Accepted Answer

The answer of Which of the following is true of...

Question 25

Which of the following would point to iron deficiency anemia as opposed to the ACI?&#10;A)anemia&#10;B)high transferrin&#10;C)low serum iron&#10;D)elevated FEP

Accepted Answer

The answer of Which of the following would point to...

Question 26

Chronic blood loss leads to&#10;A)iron deficiency anemia.&#10;B)ACI.&#10;C)megaloblastic anemia.&#10;D)hemolytic anemia.

Accepted Answer

The answer of Chronic blood loss leads to&#10;A)iron deficiency anemia.&#10;B)ACI.&#10;C)megaloblastic...

Question 27

Ringed sideroblasts are seen in&#10;A)inherited sideroblastic anemia.&#10;B)acquired hemochromatosis.&#10;C)iron deficiency anemia.&#10;D)ACI.

Accepted Answer

The answer of Ringed sideroblasts are seen in&#10;A)inherited sideroblastic anemia.&#10;B)acquired...

Deck 20: Disorders of Iron Kinetics and Heme Metabolism