AGNP EVALUATION EXAMS 2025/2026 QUESTIONS AND
SOLUTIONS RANKED A+
✔✔Hashimoto's Thyroiditis - ✔✔-Antimicrosomal antibodies to diagnose: TSH receptor
antibody test
-TSH HIGH, T4 LOW
-Start Synthroid low dose first 25mcg
✔✔Anemia Causes - ✔✔-Blood loss
-Inadequate RBC production
-excessive RBC destruction
-Hgb < 13 (men) <12 (women) (15/13 WNL)
✔✔Mean Corpuscular Volume (MCV) - ✔✔-Defines cell size
-88 WNL
-Microcytic: <80
-Macrocytic: > 96
✔✔Mean Corpuscular Hemoglobin Concentration (MCHC) - ✔✔-Defines Cell Color
-34 WNL
-Hypochromic: < 34
-Hyperchromic: > 34
✔✔Other Heme Values - ✔✔-RDW (13 WNL)
-TIBC: total iron-binding capacity
-Serum Fe
-Ferritin: storage protein for iron correlates. Highly sensitive. Specific to iron deficiency
anemia (IDA)
✔✔Anemia Symptomology - ✔✔-seen at HgB < 10
-tachy, palpitations
-pallor
-headache, fatigue, exertional dyspnea
✔✔Severe symptoms - ✔✔systolic murmur
angina
glossitis
cramps
pica/phagophasia
Neuro Sx (pernicious/B12 anemia)
✔✔Microcytic Anemias (LOW MCV) - ✔✔-iron-deficiency anemia
-thalassemia
-sideroblastic anemia
,✔✔Iron-Deficiency Anemia (IDA) - ✔✔-Hypochromic, Microcytic
-Low MCHC, MCV, Ferritin, Serum Fe, Retics
-High TIBC (looking for iron to bind!), RDW
✔✔IDA Causes - ✔✔-2/3 of IDA is GI blood loss (find the source!)
-85% of iron comes from recycled RBCs
-8yrs to get IDA from diet
✔✔IDA Oral Therapy - ✔✔6wks to fix blood
6 weeks to fix stores
Retics up after 5 days
Longer to see H/H change
Fe sulfate, gluconate, fumarate
✔✔Thalassemia - ✔✔-beta minor most common
-genetic defect
-abnormal hgb production (alpha or beta chain)
-mediterranean, Mid east, african, asian
✔✔Thalassemia Labs - ✔✔-microcytic (LOW MCV)
-hypochromic (LOW MCHC)
-Increased Fe, Ferritin
-Teardrop Red cells, Target Cells
-Splenomegaly
-(+) family hx
✔✔Sideroblastic Anemia - ✔✔-enzyme disorder: adequate Fe doesnt incorporate into
hgb. Fe enters developing erythroblast and lays in ring around mitochondria
-Ringed sideroblast cannot develop to mature RBC
✔✔SA causes - ✔✔-hereditary
-ideopathic (myelodisplastic syndrome)
-acquired: ETOH, lead, drugs (Isoniazid), RA, lymphoma, leukemia
✔✔Sideroblastic anemia Labs - ✔✔-Microcytic (low MCV)
-Fe, Ferritin HIGH (think "iron overload")
-ringed sideroblast on peripheral smear
✔✔Macrocytic Anemias (High MCV) - ✔✔-B12 deficiency/Pernicious Anemia
-Folate Deficiency
✔✔B12 deficiency Causes - ✔✔pernicious anemia (autoimmune, no intrinsic factor)
S/P gastric bypass
long-term vegetarians
, ✔✔B12 deficiency s/sx-NEURO - ✔✔atrophic glossitis
neuropathy
memory/dementia
depression
balance
position/vibration sense (-)
ataxia
anorexia/weight loss/diarrhea
✔✔B12 deficiency labs - ✔✔-Macrocytic (High MCV)
-Normochromic (normal MCHC)
-Low Retics
-Oval macrocytes
(+) antibodies to intrinsic factor=pernicious anemia
-ELEVATED methomalynate AND homocysteine
✔✔B12 deficiency Treatment - ✔✔-IM b12 1000mcg daily for 1 week
-Weekly for one month after
-Monthly for life
✔✔Folate Deficiency Causes - ✔✔-dilantin, tegretol, phenobarb, AZT, ETOH
-dialysis
-malabsorption syndromes
-celiac sprue
✔✔Folate Labs - ✔✔-NORMAL methomalynate
-HIGH homocysteine
✔✔Folate treatment - ✔✔Folic Acid 1mg PO daily
✔✔Anemia of Chronic Disease Causes - ✔✔-common inflammatory disorders
-HIV
-malignancy
✔✔ACD Labs - ✔✔-Low or Normal MCV
-Low or normal MCHC
-High or normal Ferritin
-normal TIBC
-Low Fe
✔✔Normochromic w/ INCREASED retic Count - ✔✔-hemolytic anemias-Sickle Cell
Anemia
✔✔Sickle Cell Anemia - ✔✔-Hemolysis w/ infection or certain drugs/foods
-sulfonamides
SOLUTIONS RANKED A+
✔✔Hashimoto's Thyroiditis - ✔✔-Antimicrosomal antibodies to diagnose: TSH receptor
antibody test
-TSH HIGH, T4 LOW
-Start Synthroid low dose first 25mcg
✔✔Anemia Causes - ✔✔-Blood loss
-Inadequate RBC production
-excessive RBC destruction
-Hgb < 13 (men) <12 (women) (15/13 WNL)
✔✔Mean Corpuscular Volume (MCV) - ✔✔-Defines cell size
-88 WNL
-Microcytic: <80
-Macrocytic: > 96
✔✔Mean Corpuscular Hemoglobin Concentration (MCHC) - ✔✔-Defines Cell Color
-34 WNL
-Hypochromic: < 34
-Hyperchromic: > 34
✔✔Other Heme Values - ✔✔-RDW (13 WNL)
-TIBC: total iron-binding capacity
-Serum Fe
-Ferritin: storage protein for iron correlates. Highly sensitive. Specific to iron deficiency
anemia (IDA)
✔✔Anemia Symptomology - ✔✔-seen at HgB < 10
-tachy, palpitations
-pallor
-headache, fatigue, exertional dyspnea
✔✔Severe symptoms - ✔✔systolic murmur
angina
glossitis
cramps
pica/phagophasia
Neuro Sx (pernicious/B12 anemia)
✔✔Microcytic Anemias (LOW MCV) - ✔✔-iron-deficiency anemia
-thalassemia
-sideroblastic anemia
,✔✔Iron-Deficiency Anemia (IDA) - ✔✔-Hypochromic, Microcytic
-Low MCHC, MCV, Ferritin, Serum Fe, Retics
-High TIBC (looking for iron to bind!), RDW
✔✔IDA Causes - ✔✔-2/3 of IDA is GI blood loss (find the source!)
-85% of iron comes from recycled RBCs
-8yrs to get IDA from diet
✔✔IDA Oral Therapy - ✔✔6wks to fix blood
6 weeks to fix stores
Retics up after 5 days
Longer to see H/H change
Fe sulfate, gluconate, fumarate
✔✔Thalassemia - ✔✔-beta minor most common
-genetic defect
-abnormal hgb production (alpha or beta chain)
-mediterranean, Mid east, african, asian
✔✔Thalassemia Labs - ✔✔-microcytic (LOW MCV)
-hypochromic (LOW MCHC)
-Increased Fe, Ferritin
-Teardrop Red cells, Target Cells
-Splenomegaly
-(+) family hx
✔✔Sideroblastic Anemia - ✔✔-enzyme disorder: adequate Fe doesnt incorporate into
hgb. Fe enters developing erythroblast and lays in ring around mitochondria
-Ringed sideroblast cannot develop to mature RBC
✔✔SA causes - ✔✔-hereditary
-ideopathic (myelodisplastic syndrome)
-acquired: ETOH, lead, drugs (Isoniazid), RA, lymphoma, leukemia
✔✔Sideroblastic anemia Labs - ✔✔-Microcytic (low MCV)
-Fe, Ferritin HIGH (think "iron overload")
-ringed sideroblast on peripheral smear
✔✔Macrocytic Anemias (High MCV) - ✔✔-B12 deficiency/Pernicious Anemia
-Folate Deficiency
✔✔B12 deficiency Causes - ✔✔pernicious anemia (autoimmune, no intrinsic factor)
S/P gastric bypass
long-term vegetarians
, ✔✔B12 deficiency s/sx-NEURO - ✔✔atrophic glossitis
neuropathy
memory/dementia
depression
balance
position/vibration sense (-)
ataxia
anorexia/weight loss/diarrhea
✔✔B12 deficiency labs - ✔✔-Macrocytic (High MCV)
-Normochromic (normal MCHC)
-Low Retics
-Oval macrocytes
(+) antibodies to intrinsic factor=pernicious anemia
-ELEVATED methomalynate AND homocysteine
✔✔B12 deficiency Treatment - ✔✔-IM b12 1000mcg daily for 1 week
-Weekly for one month after
-Monthly for life
✔✔Folate Deficiency Causes - ✔✔-dilantin, tegretol, phenobarb, AZT, ETOH
-dialysis
-malabsorption syndromes
-celiac sprue
✔✔Folate Labs - ✔✔-NORMAL methomalynate
-HIGH homocysteine
✔✔Folate treatment - ✔✔Folic Acid 1mg PO daily
✔✔Anemia of Chronic Disease Causes - ✔✔-common inflammatory disorders
-HIV
-malignancy
✔✔ACD Labs - ✔✔-Low or Normal MCV
-Low or normal MCHC
-High or normal Ferritin
-normal TIBC
-Low Fe
✔✔Normochromic w/ INCREASED retic Count - ✔✔-hemolytic anemias-Sickle Cell
Anemia
✔✔Sickle Cell Anemia - ✔✔-Hemolysis w/ infection or certain drugs/foods
-sulfonamides
