Anemias MCQs

32 MCQs with clinical pearls · MBBS Biochemistry · Prof Jariya

Topics covered (8)

Iron Deficiency Anaemia — 7 MCQs
Megaloblastic Anaemia — 6 MCQs
Haemolytic Anaemia — 5 MCQs
Anaemia of Chronic Disease — 3 MCQs
Sideroblastic Anaemia — 3 MCQs
Aplastic Anaemia — 3 MCQs
Anaemia — Clinical Integration — 3 MCQs
Anaemia Classification — 2 MCQs

Sample MCQs with clinical pearls

A 19-year-old girl with menorrhagia reports craving and eating ice compulsively (pagophagia). Her Hb is 7.5 g/dL, MCV 65 fL. This craving is most likely due to:

A) Calcium deficiency

B) Copper deficiency

C) Folate deficiency

D) Iron deficiency ✔

E) Vitamin B12 deficiency

PICA = craving for non-nutritive substances — THREE main causes: 1. IRON DEFICIENCY (most common) — pagophagia (ice, most specific for IDA), geophagia (dirt/clay), amylophagia (starch) 2. ZINC DEFICIENCY — also causes geophagia, hypogeusia (loss of taste), poor wound healing, acrodermatitis enteropathica 3. PSYCHOLOGICAL DISORDERS — OCD, autism spectrum, intellectual disability, pregnancy Other IDA features: KOILONYCHIA (spoon nails), GLOSSITIS, ANGULAR STOMATITIS, Plummer-Vinson syndrome (IDA + oesophageal web + dysphagia → risk of oesophageal SCC). MEMORY: "Pica causes: Iron, Zinc, Psychological. Pagophagia (ice) = most specific for IDA"

A 25-year-old South Asian woman has MCV 68 fL and Hb 10.5 g/dL. Her serum ferritin is NORMAL and TIBC is NORMAL. RBC count is elevated. Which diagnosis fits best?

A) Anaemia of chronic disease

B) Beta-thalassaemia trait ✔

C) Iron deficiency anaemia

D) Lead poisoning

E) Sideroblastic anaemia

DISTINGUISHING IDA from THALASSAEMIA TRAIT: IDA Thal Trait Ferritin: LOW NORMAL TIBC: HIGH NORMAL Serum iron: LOW NORMAL RBC count: LOW/normal HIGH (many small RBCs) RDW: HIGH NORMAL/mildly high Hb electro: Normal HbA2 elevated (>3.5%) Mentzer index: >13 <13 (MCV/RBC count) KEY: Normal iron studies + microcytosis + high RBC count + ethnic background = THALASSAEMIA TRAIT. MEMORY: "Thal trait: iron studies normal, RBC count high, Mentzer <13"

A patient with Crohn's disease affecting the terminal ileum for 10 years develops megaloblastic anaemia with neurological features. The most likely nutritional deficiency is:

A) Folate

B) Iron

C) Thiamine

D) Vitamin B12 ✔

E) Vitamin B6

TERMINAL ILEUM = site of B12-IF complex absorption. Crohn's disease (and surgical resection) of terminal ileum → B12 malabsorption → deficiency develops after years (large liver stores of B12, takes 3-5 years to deplete). Contrast: FOLATE stores last only 3-4 MONTHS — deficiency develops faster. Other causes of B12 malabsorption from terminal ileum: ileectomy, tropical sprue, bacterial overgrowth (bacteria consume B12), fish tapeworm. Folate deficiency more common in: pregnancy, malnutrition, alcohol (poor diet + impairs absorption), malabsorption (coeliac — proximal small bowel), antifolate drugs. MEMORY: "Terminal ileum disease = B12 deficiency (takes years). Proximal = Folate deficiency."

These are three of 32 MCQs in this section. Every question carries a clinical pearl explaining the reasoning.

Open MCQ Arena →