Anemia is a common and clinically important condition characterized by a deficiency in red blood cells or hemoglobin, leading to reduced oxygen-carrying capacity of the blood. Understanding the underlying pathophysiology, a key topic in the Patient care 4 curriculum, is essential for correctly classifying and managing the different types of anemia. From the microcytic anemia of iron deficiency to the macrocytic anemias caused by vitamin deficiencies, this quiz will test your knowledge on the mechanisms, lab findings, and clinical presentation of these diverse hematologic disorders.
1. Anemia is fundamentally defined as a decrease in:
- a. White blood cell count
- b. Platelet count
- c. Circulating red blood cell (RBC) mass
- d. Serum glucose
Answer: c. Circulating red blood cell (RBC) mass
2. Which red blood cell index is most useful for classifying anemia into microcytic, normocytic, and macrocytic types?
- a. Mean Corpuscular Hemoglobin (MCH)
- b. Mean Corpuscular Hemoglobin Concentration (MCHC)
- c. Red Cell Distribution Width (RDW)
- d. Mean Corpuscular Volume (MCV)
Answer: d. Mean Corpuscular Volume (MCV)
3. Iron deficiency anemia is the most common cause of which type of anemia?
- a. Microcytic anemia (MCV < 80 fL)
- b. Normocytic anemia (MCV 80-100 fL)
- c. Macrocytic anemia (MCV > 100 fL)
- d. Hemolytic anemia
Answer: a. Microcytic anemia (MCV < 80 fL)
4. The pathophysiology of iron deficiency anemia involves:
- a. Impaired DNA synthesis.
- b. Destruction of red blood cells.
- c. Inadequate iron supply for heme synthesis within RBC precursors.
- d. Decreased production of erythropoietin.
Answer: c. Inadequate iron supply for heme synthesis within RBC precursors.
5. Which laboratory value is the most sensitive and specific indicator of total body iron stores?
- a. Serum iron
- b. Hemoglobin
- c. Serum ferritin
- d. Total Iron Binding Capacity (TIBC)
Answer: c. Serum ferritin
6. The “Pathophysiology of Anemias” is a specific learning module in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
7. A deficiency in Vitamin B12 or Folic Acid leads to which type of anemia?
- a. Microcytic
- b. Normocytic
- c. Macrocytic (megaloblastic)
- d. Aplastic
Answer: c. Macrocytic (megaloblastic)
8. The underlying pathophysiology of megaloblastic anemia is:
- a. Impaired heme synthesis.
- b. Impaired globin chain synthesis.
- c. Impaired DNA synthesis and ineffective erythropoiesis.
- d. Autoimmune destruction of red blood cells.
Answer: c. Impaired DNA synthesis and ineffective erythropoiesis.
9. A patient with pernicious anemia lacks which of the following, leading to Vitamin B12 deficiency?
- a. Adequate dietary B12 intake
- b. Intrinsic factor
- c. Folic acid
- d. Iron
Answer: b. Intrinsic factor
10. Anemia of chronic disease (ACD) or anemia of inflammation is typically characterized by which lab findings?
- a. Low ferritin, high TIBC, low serum iron
- b. High ferritin, low TIBC, low serum iron
- c. High MCV, low B12 level
- d. A positive Coombs test
Answer: b. High ferritin, low TIBC, low serum iron
11. The therapeutics of anemia are covered in the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
12. Hepcidin is a key regulatory hormone in iron homeostasis. In anemia of inflammation, hepcidin levels are:
- a. Decreased, leading to increased iron absorption.
- b. Increased, leading to decreased iron absorption and release from stores.
- c. Unchanged.
- d. Undetectable.
Answer: b. Increased, leading to decreased iron absorption and release from stores.
13. Which of the following symptoms is unique to Vitamin B12 deficiency compared to folate deficiency?
- a. Fatigue
- b. Macrocytic anemia
- c. Neurological symptoms like paresthesias and gait problems.
- d. Pallor
Answer: c. Neurological symptoms like paresthesias and gait problems.
14. Anemia of chronic kidney disease (CKD) is primarily caused by:
- a. A deficiency of iron.
- b. A deficiency of erythropoietin (EPO) production by the kidneys.
- c. A deficiency of Vitamin B12.
- d. Blood loss during dialysis.
Answer: b. A deficiency of erythropoietin (EPO) production by the kidneys.
15. What does a high Red Cell Distribution Width (RDW) indicate?
- a. All red blood cells are the same size.
- b. There is a high degree of variation in red blood cell size (anisocytosis).
- c. The patient has macrocytic anemia.
- d. The patient has microcytic anemia.
Answer: b. There is a high degree of variation in red blood cell size (anisocytosis).
16. Which of the following is a classic symptom of iron deficiency anemia?
- a. Jaundice
- b. Pica (craving non-food substances like ice or clay)
- c. A beefy, red tongue
- d. Photosensitivity
Answer: b. Pica (craving non-food substances like ice or clay)
17. The management of colorectal cancer is often linked to anemia because:
- a. Chemotherapy causes anemia.
- b. Right-sided colon tumors can cause chronic, slow blood loss leading to iron deficiency anemia.
- c. Anemia is a risk factor for developing colon cancer.
- d. Both a and b are correct.
Answer: d. Both a and b are correct.
18. Hemolytic anemia is characterized by:
- a. Decreased production of RBCs.
- b. Premature destruction of RBCs.
- c. Ineffective DNA synthesis.
- d. Inadequate hemoglobin synthesis.
Answer: b. Premature destruction of RBCs.
19. A patient taking which of the following medications long-term is at risk for developing Vitamin B12 deficiency?
- a. Metformin
- b. Atorvastatin
- c. Lisinopril
- d. Aspirin
Answer: a. Metformin
20. An active learning session on anemia is part of the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
21. A peripheral blood smear from a patient with iron deficiency would likely show RBCs that are:
- a. Macrocytic and hyperchromic
- b. Normocytic and normochromic
- c. Microcytic and hypochromic
- d. Sickle-shaped
Answer: c. Microcytic and hypochromic
22. Which of the following is the most common cause of iron deficiency anemia in an adult male?
- a. Poor dietary intake
- b. Celiac disease
- c. Chronic gastrointestinal blood loss
- d. Increased iron requirements
Answer: c. Chronic gastrointestinal blood loss
23. Thalassemia is a genetic disorder that results in:
- a. Impaired production of globin chains, leading to microcytic anemia.
- b. A lack of intrinsic factor.
- c. An autoimmune destruction of RBCs.
- d. A deficiency of erythropoietin.
Answer: a. Impaired production of globin chains, leading to microcytic anemia.
24. A patient with macrocytic anemia due to alcoholism is most likely deficient in:
- a. Iron
- b. Vitamin B12
- c. Folic Acid
- d. Vitamin K
Answer: c. Folic Acid
25. A high reticulocyte count in a patient with anemia suggests:
- a. The bone marrow is not responding properly.
- b. The bone marrow is responding to the anemia by increasing RBC production.
- c. The patient has aplastic anemia.
- d. The patient has a vitamin deficiency.
Answer: b. The bone marrow is responding to the anemia by increasing RBC production.
26. The pathophysiology of sickle cell anemia involves:
- a. A point mutation in the beta-globin chain that causes hemoglobin to polymerize and RBCs to deform.
- b. A deficiency of iron.
- c. An autoimmune reaction.
- d. A lack of erythropoietin.
Answer: a. A point mutation in the beta-globin chain that causes hemoglobin to polymerize and RBCs to deform.
27. A patient with end-stage renal disease and anemia will have low levels of which hormone?
- a. Insulin
- b. Thyroxine
- c. Erythropoietin
- d. Cortisol
Answer: c. Erythropoietin
28. An active learning session on anemias is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
29. In anemia of chronic disease, iron is trapped inside macrophages by the action of:
- a. Ferritin
- b. Transferrin
- c. Hepcidin
- d. Hemoglobin
Answer: c. Hepcidin
30. Which of the following is a classic symptom of anemia?
- a. High energy levels
- b. Flushed, warm skin
- c. Fatigue and pallor
- d. High blood pressure
Answer: c. Fatigue and pallor
31. In contrast to iron deficiency anemia, the TIBC in anemia of chronic disease is typically:
- a. High
- b. Low or normal
- c. Unchanged
- d. Markedly elevated
Answer: b. Low or normal
32. A peripheral blood smear from a patient with megaloblastic anemia would show:
- a. Small, pale red blood cells.
- b. Sickle-shaped cells.
- c. Schistocytes.
- d. Large, oval-shaped red blood cells (macro-ovalocytes) and hypersegmented neutrophils.
Answer: d. Large, oval-shaped red blood cells (macro-ovalocytes) and hypersegmented neutrophils.
33. The pathophysiology of anemia is a lecture topic within which module?
- a. Module 6: Colorectal Cancer
- b. Module 1: PUD and GERD
- c. Module 4: Gastrointestinal Infections
- d. Module 5: Nutrition & Weight Management
Answer: a. Module 6: Colorectal Cancer
34. Aplastic anemia is a serious condition characterized by:
- a. Premature destruction of RBCs.
- b. A deficiency of all blood cell types due to bone marrow failure.
- c. Iron overload.
- d. A lack of Vitamin B12.
Answer: b. A deficiency of all blood cell types due to bone marrow failure.
35. Why must folic acid not be given alone to treat macrocytic anemia until B12 deficiency is ruled out?
- a. It can correct the hematologic abnormality while allowing the neurologic damage of B12 deficiency to progress.
- b. It is not effective for macrocytic anemia.
- c. It will cause the B12 levels to decrease further.
- d. The combination is toxic.
Answer: a. It can correct the hematologic abnormality while allowing the neurologic damage of B12 deficiency to progress.
36. The most common cause of anemia worldwide is:
- a. Vitamin B12 deficiency
- b. Folate deficiency
- c. Anemia of chronic disease
- d. Iron deficiency
Answer: d. Iron deficiency
37. Which of the following is NOT a cause of iron deficiency?
- a. Chronic blood loss
- b. Increased iron requirements (e.g., pregnancy)
- c. Inadequate dietary intake
- d. Chronic inflammation
Answer: d. Chronic inflammation
38. The role of a pharmacist in the pathophysiology of anemia is to:
- a. Perform bone marrow biopsies.
- b. Identify potential drug-induced causes of anemia or deficiencies.
- c. Prescribe blood transfusions.
- d. Diagnose the specific type of anemia without lab tests.
Answer: b. Identify potential drug-induced causes of anemia or deficiencies.
39. A patient’s lab results show: Hgb 9.2 g/dL, MCV 75 fL, Ferritin 8 ng/mL, TIBC 450 mcg/dL. This is most consistent with:
- a. Vitamin B12 deficiency
- b. Anemia of chronic disease
- c. Iron deficiency anemia
- d. Folic acid deficiency
Answer: c. Iron deficiency anemia
40. The curriculum includes a required reading on anemias from DiPiro’s Pharmacotherapy.
- a. True
- b. False
Answer: a. True
41. Anemia of chronic disease is often seen in patients with which of the following conditions?
- a. Rheumatoid arthritis
- b. Chronic kidney disease
- c. Malignancy
- d. All of the above
Answer: d. All of the above
42. Which of the following is a key component of hemoglobin?
- a. Iron
- b. Copper
- c. Zinc
- d. Magnesium
Answer: a. Iron
43. A direct Coombs test is used to diagnose what type of anemia?
- a. Iron deficiency anemia
- b. Autoimmune hemolytic anemia
- c. Megaloblastic anemia
- d. Aplastic anemia
Answer: b. Autoimmune hemolytic anemia
44. What is the role of transferrin?
- a. It is the storage form of iron.
- b. It is the main transport protein for iron in the blood.
- c. It regulates iron absorption.
- d. It is a component of hemoglobin.
Answer: b. It is the main transport protein for iron in the blood.
45. Koilonychia (spoon-shaped nails) is a physical sign associated with severe, long-standing:
- a. Vitamin B12 deficiency
- b. Anemia of chronic disease
- c. Iron deficiency anemia
- d. Hemolytic anemia
Answer: c. Iron deficiency anemia
46. The lifespan of a normal red blood cell is approximately:
- a. 30 days
- b. 60 days
- c. 90 days
- d. 120 days
Answer: d. 120 days
47. A “left shift” in the oxygen-hemoglobin dissociation curve means that hemoglobin has a(n) ____ affinity for oxygen.
- a. increased
- b. decreased
- c. unchanged
- d. absent
Answer: a. increased
48. An active learning session on anemia is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
49. G6PD deficiency is a genetic disorder that can lead to:
- a. Iron deficiency anemia
- b. Hemolytic anemia when the patient is exposed to certain oxidative drugs or foods.
- c. Macrocytic anemia.
- d. Aplastic anemia.
Answer: b. Hemolytic anemia when the patient is exposed to certain oxidative drugs or foods.
50. The ultimate reason for understanding the pathophysiology of anemias is to:
- a. Order the correct lab tests.
- b. Be able to recommend and manage targeted, cause-specific therapy.
- c. Impress physicians with knowledge of rare disorders.
- d. Memorize lab values.
Answer: b. Be able to recommend and manage targeted, cause-specific therapy.