Family Medicine EOR Hematology Exam
(2026/2027) | QUESTIONS AND VERIFIED
ANSWERS
Physician Assistant (PA) Family Medicine End of Rotation (EOR) Hematology Examination |
Core Domains: Anemia (Microcytic, Macrocytic, Normocytic) Diagnosis & Management,
Bleeding Disorders (Coagulopathies, Platelet Disorders), Thrombotic Disorders &
Anticoagulation Therapy, Hematologic Malignancies Overview (Leukemia, Lymphoma,
Myeloma) for Primary Care, Benign Leukocyte Disorders, Splenomegaly & Lymphadenopathy
Evaluation, Interpretation of Common Hematologic Labs (CBC with diff, Coagulation panels),
and Transfusion Medicine Basics | Physician Assistant Education Focus | Specialty-Specific
EOR Exam Format
Exam Structure
The Family Medicine EOR Hematology exam for the 2026/2027 academic cycle is a 75-question,
multiple-choice question (MCQ) examination.
Introduction
This Family Medicine EOR Hematology exam guide for the 2026/2027 cycle prepares Physician
Assistant students for the hematology-focused End of Rotation examination. The content
assesses the ability to diagnose, manage, and appropriately refer common blood disorders in an
outpatient primary care setting, with an emphasis on lab interpretation, initial treatment, and
longitudinal care coordination.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green,
followed by detailed rationales that explain CBC/coagulation profile abnormalities, outline
stepwise diagnostic approaches, justify initial therapeutic interventions (e.g., iron
supplementation, anticoagulation initiation), and specify clear referral criteria to hematology.
Question 1: A 32-year-old woman presents with fatigue and pallor. CBC shows hemoglobin 9.8
g/dL, MCV 72 fL, serum ferritin 8 ng/mL, and TIBC elevated. Which of the following is the most
appropriate initial treatment?
(A) Vitamin B12 injections
(B) Folic acid supplementation
(C) Oral ferrous sulfate
,(D) Erythropoietin
(E) Blood transfusion
Correct Answer: (C) Oral ferrous sulfate
Rationale: This patient has microcytic anemia with low ferritin and high TIBC—diagnostic of
iron deficiency anemia. First-line treatment is oral iron (e.g., ferrous sulfate 325 mg once or
twice daily). Vitamin B12 and folate treat macrocytic anemias. Erythropoietin is used in anemia
of chronic kidney disease. Transfusion is reserved for severe, symptomatic anemia (Hb <7–8
g/dL or cardiovascular instability). In premenopausal women, menstrual blood loss is the most
common cause; in postmenopausal women or men, GI blood loss must be ruled out (e.g.,
colonoscopy).
Question 2: A 68-year-old man presents with new-onset fatigue. CBC reveals hemoglobin 10.2
g/dL, MCV 92 fL, reticulocyte index <2%, and normal iron studies. He has stage 3 CKD (eGFR
38 mL/min). Which of the following is the most likely cause of his anemia?
(A) Iron deficiency
(B) Vitamin B12 deficiency
(C) Anemia of chronic disease
(D) Hemolytic anemia
(E) Aplastic anemia
Correct Answer: (C) Anemia of chronic disease
Rationale: Anemia of chronic disease (ACD), also called anemia of inflammation, is the second
most common anemia worldwide and is frequently seen in patients with chronic kidney disease
(CKD), autoimmune disorders, or malignancy. It is typically normocytic/normochromic with
low reticulocyte count, low serum iron, low TIBC, and normal/high ferritin—reflecting
functional iron deficiency due to hepcidin-mediated iron sequestration. In CKD, erythropoietin
deficiency also contributes. Treatment focuses on managing the underlying condition;
erythropoiesis-stimulating agents (ESAs) may be used in select CKD patients per guidelines.
,Question 3: A 45-year-old woman presents with easy bruising and prolonged bleeding after
dental extraction. PT is normal, PTT is prolonged, and mixing study corrects the PTT. Platelet
count is normal. Which of the following is the most likely diagnosis?
(A) Von Willebrand disease
(B) Hemophilia A
(C) Vitamin K deficiency
(D) Disseminated intravascular coagulation (DIC)
(E) Immune thrombocytopenia (ITP)
Correct Answer: (A) Von Willebrand disease
Rationale: Von Willebrand disease (vWD) is the most common inherited bleeding disorder. It
causes mucocutaneous bleeding (epistaxis, menorrhagia, bruising) and prolonged PTT due to
deficiency or dysfunction of von Willebrand factor (vWF), which stabilizes factor VIII. A mixing
study that corrects the PTT suggests a factor deficiency (not an inhibitor). vWD often has normal
platelets and PT. Hemophilia A (factor VIII deficiency) also prolongs PTT but typically presents
with hemarthroses/muscle hematomas, not mucosal bleeding. Vitamin K deficiency prolongs
both PT and PTT. DIC shows thrombocytopenia and elevated D-dimer.
Question 4: A 72-year-old man with atrial fibrillation is started on apixaban for stroke
prevention. Two weeks later, he presents with melena and hemoglobin drop from 14 to 9 g/dL.
Which of the following is the most appropriate reversal agent if life-threatening bleeding occurs?
(A) Vitamin K
(B) Fresh frozen plasma (FFP)
(C) Protamine sulfate
, (D) Andexanet alfa
(E) Desmopressin
Correct Answer: (D) Andexanet alfa
Rationale: Apixaban is a direct factor Xa inhibitor. Andexanet alfa is a recombinant modified
factor Xa protein that acts as a decoy to reverse factor Xa inhibitors (apixaban, rivaroxaban).
Vitamin K and FFP reverse warfarin (vitamin K antagonist). Protamine reverses heparin.
Desmopressin is used in mild hemophilia A or vWD. For non-life-threatening bleeding, holding
the DOAC and supportive care (e.g., PPI for GI bleed) is sufficient. Andexanet alfa is reserved for
major or life-threatening hemorrhage.
Question 5: A 55-year-old woman presents with fatigue and weight loss. CBC shows
hemoglobin 8.5 g/dL, MCV 105 fL, WBC 3,200/μL, and platelets 95,000/μL. Peripheral smear
reveals hypersegmented neutrophils. Which of the following tests should be ordered next?
(A) Serum iron and ferritin
(B) Reticulocyte count
(C) Serum vitamin B12 and folate levels
(D) Direct Coombs test
(E) Hemoglobin electrophoresis
Correct Answer: (C) Serum vitamin B12 and folate levels
Rationale: Macrocytic anemia with pancytopenia and hypersegmented neutrophils is classic
for megaloblastic anemia due to vitamin B12 or folate deficiency. B12 deficiency may also cause
neurologic symptoms (e.g., paresthesias, ataxia). Initial workup includes serum B12 and folate
levels. If B12 is low, intrinsic factor and parietal cell antibodies help confirm pernicious anemia.
Reticulocyte count is low in megaloblastic anemia (ineffective erythropoiesis). Iron studies are
for microcytic anemia; Coombs test for hemolytic anemia; Hb electrophoresis for thalassemia.
(2026/2027) | QUESTIONS AND VERIFIED
ANSWERS
Physician Assistant (PA) Family Medicine End of Rotation (EOR) Hematology Examination |
Core Domains: Anemia (Microcytic, Macrocytic, Normocytic) Diagnosis & Management,
Bleeding Disorders (Coagulopathies, Platelet Disorders), Thrombotic Disorders &
Anticoagulation Therapy, Hematologic Malignancies Overview (Leukemia, Lymphoma,
Myeloma) for Primary Care, Benign Leukocyte Disorders, Splenomegaly & Lymphadenopathy
Evaluation, Interpretation of Common Hematologic Labs (CBC with diff, Coagulation panels),
and Transfusion Medicine Basics | Physician Assistant Education Focus | Specialty-Specific
EOR Exam Format
Exam Structure
The Family Medicine EOR Hematology exam for the 2026/2027 academic cycle is a 75-question,
multiple-choice question (MCQ) examination.
Introduction
This Family Medicine EOR Hematology exam guide for the 2026/2027 cycle prepares Physician
Assistant students for the hematology-focused End of Rotation examination. The content
assesses the ability to diagnose, manage, and appropriately refer common blood disorders in an
outpatient primary care setting, with an emphasis on lab interpretation, initial treatment, and
longitudinal care coordination.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green,
followed by detailed rationales that explain CBC/coagulation profile abnormalities, outline
stepwise diagnostic approaches, justify initial therapeutic interventions (e.g., iron
supplementation, anticoagulation initiation), and specify clear referral criteria to hematology.
Question 1: A 32-year-old woman presents with fatigue and pallor. CBC shows hemoglobin 9.8
g/dL, MCV 72 fL, serum ferritin 8 ng/mL, and TIBC elevated. Which of the following is the most
appropriate initial treatment?
(A) Vitamin B12 injections
(B) Folic acid supplementation
(C) Oral ferrous sulfate
,(D) Erythropoietin
(E) Blood transfusion
Correct Answer: (C) Oral ferrous sulfate
Rationale: This patient has microcytic anemia with low ferritin and high TIBC—diagnostic of
iron deficiency anemia. First-line treatment is oral iron (e.g., ferrous sulfate 325 mg once or
twice daily). Vitamin B12 and folate treat macrocytic anemias. Erythropoietin is used in anemia
of chronic kidney disease. Transfusion is reserved for severe, symptomatic anemia (Hb <7–8
g/dL or cardiovascular instability). In premenopausal women, menstrual blood loss is the most
common cause; in postmenopausal women or men, GI blood loss must be ruled out (e.g.,
colonoscopy).
Question 2: A 68-year-old man presents with new-onset fatigue. CBC reveals hemoglobin 10.2
g/dL, MCV 92 fL, reticulocyte index <2%, and normal iron studies. He has stage 3 CKD (eGFR
38 mL/min). Which of the following is the most likely cause of his anemia?
(A) Iron deficiency
(B) Vitamin B12 deficiency
(C) Anemia of chronic disease
(D) Hemolytic anemia
(E) Aplastic anemia
Correct Answer: (C) Anemia of chronic disease
Rationale: Anemia of chronic disease (ACD), also called anemia of inflammation, is the second
most common anemia worldwide and is frequently seen in patients with chronic kidney disease
(CKD), autoimmune disorders, or malignancy. It is typically normocytic/normochromic with
low reticulocyte count, low serum iron, low TIBC, and normal/high ferritin—reflecting
functional iron deficiency due to hepcidin-mediated iron sequestration. In CKD, erythropoietin
deficiency also contributes. Treatment focuses on managing the underlying condition;
erythropoiesis-stimulating agents (ESAs) may be used in select CKD patients per guidelines.
,Question 3: A 45-year-old woman presents with easy bruising and prolonged bleeding after
dental extraction. PT is normal, PTT is prolonged, and mixing study corrects the PTT. Platelet
count is normal. Which of the following is the most likely diagnosis?
(A) Von Willebrand disease
(B) Hemophilia A
(C) Vitamin K deficiency
(D) Disseminated intravascular coagulation (DIC)
(E) Immune thrombocytopenia (ITP)
Correct Answer: (A) Von Willebrand disease
Rationale: Von Willebrand disease (vWD) is the most common inherited bleeding disorder. It
causes mucocutaneous bleeding (epistaxis, menorrhagia, bruising) and prolonged PTT due to
deficiency or dysfunction of von Willebrand factor (vWF), which stabilizes factor VIII. A mixing
study that corrects the PTT suggests a factor deficiency (not an inhibitor). vWD often has normal
platelets and PT. Hemophilia A (factor VIII deficiency) also prolongs PTT but typically presents
with hemarthroses/muscle hematomas, not mucosal bleeding. Vitamin K deficiency prolongs
both PT and PTT. DIC shows thrombocytopenia and elevated D-dimer.
Question 4: A 72-year-old man with atrial fibrillation is started on apixaban for stroke
prevention. Two weeks later, he presents with melena and hemoglobin drop from 14 to 9 g/dL.
Which of the following is the most appropriate reversal agent if life-threatening bleeding occurs?
(A) Vitamin K
(B) Fresh frozen plasma (FFP)
(C) Protamine sulfate
, (D) Andexanet alfa
(E) Desmopressin
Correct Answer: (D) Andexanet alfa
Rationale: Apixaban is a direct factor Xa inhibitor. Andexanet alfa is a recombinant modified
factor Xa protein that acts as a decoy to reverse factor Xa inhibitors (apixaban, rivaroxaban).
Vitamin K and FFP reverse warfarin (vitamin K antagonist). Protamine reverses heparin.
Desmopressin is used in mild hemophilia A or vWD. For non-life-threatening bleeding, holding
the DOAC and supportive care (e.g., PPI for GI bleed) is sufficient. Andexanet alfa is reserved for
major or life-threatening hemorrhage.
Question 5: A 55-year-old woman presents with fatigue and weight loss. CBC shows
hemoglobin 8.5 g/dL, MCV 105 fL, WBC 3,200/μL, and platelets 95,000/μL. Peripheral smear
reveals hypersegmented neutrophils. Which of the following tests should be ordered next?
(A) Serum iron and ferritin
(B) Reticulocyte count
(C) Serum vitamin B12 and folate levels
(D) Direct Coombs test
(E) Hemoglobin electrophoresis
Correct Answer: (C) Serum vitamin B12 and folate levels
Rationale: Macrocytic anemia with pancytopenia and hypersegmented neutrophils is classic
for megaloblastic anemia due to vitamin B12 or folate deficiency. B12 deficiency may also cause
neurologic symptoms (e.g., paresthesias, ataxia). Initial workup includes serum B12 and folate
levels. If B12 is low, intrinsic factor and parietal cell antibodies help confirm pernicious anemia.
Reticulocyte count is low in megaloblastic anemia (ineffective erythropoiesis). Iron studies are
for microcytic anemia; Coombs test for hemolytic anemia; Hb electrophoresis for thalassemia.
