ANEMIA CASE STUDY-STUDENT VERSION
WITH 70 QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES AFTER EVERY
ANSWER/LATEST UPDATED STUDY GUIDE
2024/2025 ALREADY GRADED A
A 30 year old male patient presents with chief complaint of fatigue for the past month. During the history
the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of
stairs. He also admits to having an intense urge to eat ice all of the time. During examination you note
small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like
a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 37,
MCV 75, RDW 17, MCHC 28. What other findings would you expect to find?
a. Serum Iron that is high
b. Serum transferrin that is low
c. Serum ferritin that is high
d. TIBC that is high - ANSWER>>d. TIBC that is high
Your TIBC would be high because you would have lots of binding capacity left over, since this is most
likely Iron Deficiency anemia.
A 30 year old male patient presents with chief complaint of fatigue for the past month. During the history
the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of
stairs. He also admits to having an intense urge to eat ice all of the time. During examination you note
small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like
a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 37,
MCV 75, RDW 17, MCHC 28. What other physical exam findings would you expect to find?
a. glove and stocking parasthesia
b. wobbly gait
c. tachycardia
d. mild icterus - ANSWER>>c. tachycardia
This is most likely iron deficiency anemia based on the physical exam findings. The other options were
symptoms of B12 deficiency anemia.
A 30 year old male patient presents with chief complaint of fatigue for the past month. During the history
the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of
stairs. He also admits to having have trouble swallowing and an intense urge to eat ice all of the time.
During examination you note small cracks in the side of his mouth as well as brittle looking nails that have
an upward curve to them like a spoon. The patient also has a smooth appearance to his tongue. To
investigate the trouble swallowing you have your patient do a barium swallow and notice a web like
appearance. You run a CBC as well and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9,
hematocrit 37, MCV 75, RDW 17, MCHC 28. What is the most likely diagnosis?
, a. iron deficiency anemia
b. plummer-vision syndrome
c. anemia of chronic disease
d. B12 deficiency anemia - ANSWER>>b. plummer-vision syndrome
This patient does have iron deficiency anemia as show by the microcytic hypochromic CBC, but plummer-
vision syndrome is the combination or triad of symptoms shown here: iron deficiency anemia
demonstrated by many of these symptoms but most notably for this syndrome with glossitis, dysphagia,
and an esophageal web.
A 30 year old male patient presents with chief complaint of fatigue for the past month. During the history
the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of
stairs. He also admits to having an intense urge to eat ice all of the time. During examination you note
small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like
a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 37,
MCV 75, RDW 17, MCHC 28. What would be the most appropriate treatment for this patient?
a. Iron dextran IM 100mg x 10 doses
b. Sodium Ferric Gluconate IM 125mg x 8 doses
c. Ferrous Sulfate 325mg PO TID x 3-6 months
d. folic acid supplementation 1mg/d PO x 4 months - ANSWER>>c. 325mg PO TID x 3-6 months
PO is preferred and IV/IM is only used if PO therapy failed, they have higher iron requirements due to
chronic heamodialysis, or iron malabsorption issues.
Your patient is has iron deficiency anemia and failed oral therapy. You decide to put them on a parental
iron therapy. What option would you be most concerned about anaphylaxis with?
a. Iron Dextran
b. Sodium Ferric Gluconate (ferrlecit)
c. Iron Sucrose
d. Ferrous sulfate - ANSWER>>a. Iron Dextran
Iron dextran has a black box warning and requires a test dose to see how the patient handles it. Sodium
Ferric gluconate (ferrlecit), can also cause anaphylaxis and a test dose is recommended, but there is no
black box warning, so Iron Dextran you would worry the MOST about even though both could cause it.
You know how they love to put these kind of questions on there.
What kind of medication would you be worried about decreasing the absorption of iron therapy?
a. Lisinopril
b. Metroprolol
c. Methyldopa
d. Levothyroxine
e. doxycycline - ANSWER>>e. doxycycline
Doxycycline will decrease the iron absorption. Methyldopa, levothyroxine, AND doxycycline will all be
affected by iron therapy and their effects will be decreased DUE TO the iron. Doxy is the only one that
both decreases iron absorption and has it's effects decreased as well.
A 50 year old female with a history of SLE presents with a chief complaint of fatigue for the past month.
During the history the patient says she has noticed he gets tired very much easier than she used to when
WITH 70 QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES AFTER EVERY
ANSWER/LATEST UPDATED STUDY GUIDE
2024/2025 ALREADY GRADED A
A 30 year old male patient presents with chief complaint of fatigue for the past month. During the history
the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of
stairs. He also admits to having an intense urge to eat ice all of the time. During examination you note
small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like
a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 37,
MCV 75, RDW 17, MCHC 28. What other findings would you expect to find?
a. Serum Iron that is high
b. Serum transferrin that is low
c. Serum ferritin that is high
d. TIBC that is high - ANSWER>>d. TIBC that is high
Your TIBC would be high because you would have lots of binding capacity left over, since this is most
likely Iron Deficiency anemia.
A 30 year old male patient presents with chief complaint of fatigue for the past month. During the history
the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of
stairs. He also admits to having an intense urge to eat ice all of the time. During examination you note
small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like
a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 37,
MCV 75, RDW 17, MCHC 28. What other physical exam findings would you expect to find?
a. glove and stocking parasthesia
b. wobbly gait
c. tachycardia
d. mild icterus - ANSWER>>c. tachycardia
This is most likely iron deficiency anemia based on the physical exam findings. The other options were
symptoms of B12 deficiency anemia.
A 30 year old male patient presents with chief complaint of fatigue for the past month. During the history
the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of
stairs. He also admits to having have trouble swallowing and an intense urge to eat ice all of the time.
During examination you note small cracks in the side of his mouth as well as brittle looking nails that have
an upward curve to them like a spoon. The patient also has a smooth appearance to his tongue. To
investigate the trouble swallowing you have your patient do a barium swallow and notice a web like
appearance. You run a CBC as well and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9,
hematocrit 37, MCV 75, RDW 17, MCHC 28. What is the most likely diagnosis?
, a. iron deficiency anemia
b. plummer-vision syndrome
c. anemia of chronic disease
d. B12 deficiency anemia - ANSWER>>b. plummer-vision syndrome
This patient does have iron deficiency anemia as show by the microcytic hypochromic CBC, but plummer-
vision syndrome is the combination or triad of symptoms shown here: iron deficiency anemia
demonstrated by many of these symptoms but most notably for this syndrome with glossitis, dysphagia,
and an esophageal web.
A 30 year old male patient presents with chief complaint of fatigue for the past month. During the history
the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of
stairs. He also admits to having an intense urge to eat ice all of the time. During examination you note
small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like
a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 37,
MCV 75, RDW 17, MCHC 28. What would be the most appropriate treatment for this patient?
a. Iron dextran IM 100mg x 10 doses
b. Sodium Ferric Gluconate IM 125mg x 8 doses
c. Ferrous Sulfate 325mg PO TID x 3-6 months
d. folic acid supplementation 1mg/d PO x 4 months - ANSWER>>c. 325mg PO TID x 3-6 months
PO is preferred and IV/IM is only used if PO therapy failed, they have higher iron requirements due to
chronic heamodialysis, or iron malabsorption issues.
Your patient is has iron deficiency anemia and failed oral therapy. You decide to put them on a parental
iron therapy. What option would you be most concerned about anaphylaxis with?
a. Iron Dextran
b. Sodium Ferric Gluconate (ferrlecit)
c. Iron Sucrose
d. Ferrous sulfate - ANSWER>>a. Iron Dextran
Iron dextran has a black box warning and requires a test dose to see how the patient handles it. Sodium
Ferric gluconate (ferrlecit), can also cause anaphylaxis and a test dose is recommended, but there is no
black box warning, so Iron Dextran you would worry the MOST about even though both could cause it.
You know how they love to put these kind of questions on there.
What kind of medication would you be worried about decreasing the absorption of iron therapy?
a. Lisinopril
b. Metroprolol
c. Methyldopa
d. Levothyroxine
e. doxycycline - ANSWER>>e. doxycycline
Doxycycline will decrease the iron absorption. Methyldopa, levothyroxine, AND doxycycline will all be
affected by iron therapy and their effects will be decreased DUE TO the iron. Doxy is the only one that
both decreases iron absorption and has it's effects decreased as well.
A 50 year old female with a history of SLE presents with a chief complaint of fatigue for the past month.
During the history the patient says she has noticed he gets tired very much easier than she used to when
