Barkley Hematology Practice Exam With Detailed
Rationale And Answers Latest Update 2026
Graded A+
SECTION 1: RED BLOOD CELL DISORDERS & ANEMIAS
Question 1
A 45-year-old woman presents with fatigue, dyspnea on exertion, and
pallor. Laboratory findings reveal hemoglobin 9.5 g/dL, MCV 75 fL, and
ferritin 8 ng/mL. What is the most likely diagnosis?
A. Anemia of chronic disease
B. Vitamin B12 deficiency anemia
C. Iron deficiency anemia
D. Thalassemia minor
Correct Answer: C
Rationale: Iron deficiency anemia is characterized by microcytic
(low MCV), hypochromic anemia with low ferritin. Ferritin <30
ng/mL is the most sensitive and specific test for iron deficiency. The
classic symptoms include fatigue, dyspnea, and pallor. Anemia of
chronic disease typically shows normal or elevated ferritin with low
TIBC, while B12 deficiency is macrocytic (high MCV).
Question 2
A 68-year-old male with chronic kidney disease presents with anemia.
,Which laboratory finding is most consistent with anemia of chronic
disease?
A. Low ferritin, elevated TIBC
B. Normal ferritin, normal TIBC
C. Elevated ferritin, low TIBC
D. Low ferritin, low TIBC
Correct Answer: C
Rationale: Anemia of chronic disease is characterized by elevated or
normal ferritin (as ferritin is an acute-phase reactant), low TIBC,
and low serum iron. The underlying mechanism involves hepcidin-
mediated iron sequestration and decreased erythropoietin
production.
Question 3
A 30-year-old vegan presents with fatigue and paresthesias. Laboratory
findings reveal hemoglobin 10.5 g/dL, MCV 115 fL, and B12 level of 150
pg/mL. What is the most likely diagnosis?
A. Iron deficiency anemia
B. Vitamin B12 deficiency anemia
C. Folate deficiency anemia
D. Anemia of chronic disease
Correct Answer: B
Rationale: Vitamin B12 deficiency is characterized by macrocytic
anemia (MCV >100 fL) with neurologic symptoms including
paresthesias, memory loss, and gait abnormalities. Vegans are at
,high risk due to dietary deficiency. B12 level <200 pg/mL is
diagnostic.
Question 4
A 28-year-old female presents with heavy menstrual bleeding and fatigue.
Her hemoglobin is 8.8 g/dL, MCV 72 fL, and RDW 18%. What is the most
likely diagnosis?
A. Thalassemia minor
B. Iron deficiency anemia
C. Anemia of chronic disease
D. Sideroblastic anemia
Correct Answer: B
Rationale: Iron deficiency anemia from chronic blood loss (heavy
menses) presents with microcytic anemia (low MCV) and elevated
RDW (anisocytosis). Thalassemia minor typically has a normal RDW.
Question 5
A patient with iron deficiency anemia is started on oral ferrous sulfate.
How should the NP advise the patient to take the medication?
A. With milk
B. With vitamin C
C. On an empty stomach
D. Both B and C
Correct Answer: D
Rationale: Iron absorption is enhanced by vitamin C (ascorbic acid)
, and taking it on an empty stomach. Milk and antacids decrease
absorption.
Question 6
A patient with iron deficiency anemia has a hemoglobin of 7.5 g/dL and is
symptomatic. What is the most appropriate treatment?
A. Oral iron
B. IV iron
C. Blood transfusion
D. Erythropoietin
Correct Answer: C
Rationale: Symptomatic severe anemia (Hb <8 g/dL) may require
blood transfusion for immediate correction. Oral or IV iron is used
for less severe cases.
Question 7
A patient with anemia of chronic disease has a hemoglobin of 10 g/dL.
What is the underlying mechanism?
A. Iron deficiency
B. Hepcidin-mediated iron sequestration
C. B12 deficiency
D. Folate deficiency
Correct Answer: B
Rationale: Anemia of chronic disease is caused by hepcidin-mediated
iron sequestration and decreased erythropoietin production due to
inflammation.
Rationale And Answers Latest Update 2026
Graded A+
SECTION 1: RED BLOOD CELL DISORDERS & ANEMIAS
Question 1
A 45-year-old woman presents with fatigue, dyspnea on exertion, and
pallor. Laboratory findings reveal hemoglobin 9.5 g/dL, MCV 75 fL, and
ferritin 8 ng/mL. What is the most likely diagnosis?
A. Anemia of chronic disease
B. Vitamin B12 deficiency anemia
C. Iron deficiency anemia
D. Thalassemia minor
Correct Answer: C
Rationale: Iron deficiency anemia is characterized by microcytic
(low MCV), hypochromic anemia with low ferritin. Ferritin <30
ng/mL is the most sensitive and specific test for iron deficiency. The
classic symptoms include fatigue, dyspnea, and pallor. Anemia of
chronic disease typically shows normal or elevated ferritin with low
TIBC, while B12 deficiency is macrocytic (high MCV).
Question 2
A 68-year-old male with chronic kidney disease presents with anemia.
,Which laboratory finding is most consistent with anemia of chronic
disease?
A. Low ferritin, elevated TIBC
B. Normal ferritin, normal TIBC
C. Elevated ferritin, low TIBC
D. Low ferritin, low TIBC
Correct Answer: C
Rationale: Anemia of chronic disease is characterized by elevated or
normal ferritin (as ferritin is an acute-phase reactant), low TIBC,
and low serum iron. The underlying mechanism involves hepcidin-
mediated iron sequestration and decreased erythropoietin
production.
Question 3
A 30-year-old vegan presents with fatigue and paresthesias. Laboratory
findings reveal hemoglobin 10.5 g/dL, MCV 115 fL, and B12 level of 150
pg/mL. What is the most likely diagnosis?
A. Iron deficiency anemia
B. Vitamin B12 deficiency anemia
C. Folate deficiency anemia
D. Anemia of chronic disease
Correct Answer: B
Rationale: Vitamin B12 deficiency is characterized by macrocytic
anemia (MCV >100 fL) with neurologic symptoms including
paresthesias, memory loss, and gait abnormalities. Vegans are at
,high risk due to dietary deficiency. B12 level <200 pg/mL is
diagnostic.
Question 4
A 28-year-old female presents with heavy menstrual bleeding and fatigue.
Her hemoglobin is 8.8 g/dL, MCV 72 fL, and RDW 18%. What is the most
likely diagnosis?
A. Thalassemia minor
B. Iron deficiency anemia
C. Anemia of chronic disease
D. Sideroblastic anemia
Correct Answer: B
Rationale: Iron deficiency anemia from chronic blood loss (heavy
menses) presents with microcytic anemia (low MCV) and elevated
RDW (anisocytosis). Thalassemia minor typically has a normal RDW.
Question 5
A patient with iron deficiency anemia is started on oral ferrous sulfate.
How should the NP advise the patient to take the medication?
A. With milk
B. With vitamin C
C. On an empty stomach
D. Both B and C
Correct Answer: D
Rationale: Iron absorption is enhanced by vitamin C (ascorbic acid)
, and taking it on an empty stomach. Milk and antacids decrease
absorption.
Question 6
A patient with iron deficiency anemia has a hemoglobin of 7.5 g/dL and is
symptomatic. What is the most appropriate treatment?
A. Oral iron
B. IV iron
C. Blood transfusion
D. Erythropoietin
Correct Answer: C
Rationale: Symptomatic severe anemia (Hb <8 g/dL) may require
blood transfusion for immediate correction. Oral or IV iron is used
for less severe cases.
Question 7
A patient with anemia of chronic disease has a hemoglobin of 10 g/dL.
What is the underlying mechanism?
A. Iron deficiency
B. Hepcidin-mediated iron sequestration
C. B12 deficiency
D. Folate deficiency
Correct Answer: B
Rationale: Anemia of chronic disease is caused by hepcidin-mediated
iron sequestration and decreased erythropoietin production due to
inflammation.
