MCQs Haematology Iron, B12 and Folate PDF

**1. Which form of iron is absorbed in the duodenum?** - a\. Ferric (Fe³⁺) - b\. Ferrous (Fe²⁺) - c\. Heme iron - d\. Elemental iron\ **Answer:** b. Ferrous (Fe²⁺) **2. What is the primary iron storage protein in the body?** - a\. Ferritin - b\. Transferrin - c\. Hemosideri...

**1. Which form of iron is absorbed in the duodenum?** - a\. Ferric (Fe³⁺) - b\. Ferrous (Fe²⁺) - c\. Heme iron - d\. Elemental iron\ **Answer:** b. Ferrous (Fe²⁺) **2. What is the primary iron storage protein in the body?** - a\. Ferritin - b\. Transferrin - c\. Hemosiderin - d\. Hepcidin\ **Answer:** a. Ferritin **3. True/False (One for Each Option):** About iron absorption: - a\. Non-heme iron absorption is enhanced by vitamin C. - b\. Phytates in food inhibit iron absorption. - c\. Heme iron absorption occurs primarily in the ileum. - d\. Acidic gastric pH facilitates iron absorption.\ **Answers:** - a\. True - b\. True - c\. False - d\. True **4. Iron deficiency anemia commonly presents with which of the following symptoms?** - a\. Pica - b\. Koilonychia - c\. Fatigue - d\. All of the above\ **Answer:** d. All of the above **5. Which of the following conditions is associated with iron overload?** - a\. Hemochromatosis - b\. Anemia of chronic disease - c\. Lead poisoning - d\. Aplastic anemia\ **Answer:** a. Hemochromatosis **6. All of the following are effects of hepcidin on iron metabolism EXCEPT:** - a\. Decreases dietary iron absorption - b\. Inhibits iron release from macrophages - c\. Suppresses erythropoietin production - d\. Reduces plasma iron levels\ **Answer:** c. Suppresses erythropoietin production **7. True/False (One for Each Option):** Regarding iron transport: - a\. Transferrin transports iron in the blood. - b\. Each transferrin molecule can bind two iron atoms. - c\. Transferrin saturation decreases in iron deficiency. - d\. Ferroportin exports iron from cells to plasma.\ **Answers:** - a\. True - b\. True - c\. True - d\. True **8. The total body iron in a healthy adult male is approximately:** - a\. 1--2 grams - b\. 3--5 grams - c\. 6--8 grams - d\. 9--10 grams\ **Answer:** b. 3--5 grams **9. Which enzyme is responsible for converting ferric iron (Fe³⁺) to ferrous iron (Fe²⁺) during absorption?** - a\. Ferroportin - b\. Ferritin - c\. Dcytb (duodenal cytochrome b) - d\. Ceruloplasmin\ **Answer:** c. Dcytb (duodenal cytochrome b) **10. All of the following are laboratory findings in iron deficiency anemia EXCEPT:** - a\. Low serum ferritin - b\. Low transferrin saturation - c\. Increased serum iron - d\. Elevated total iron-binding capacity (TIBC)\ **Answer:** c. Increased serum iron **11. Fill-in-the-Blank:** The gold standard for diagnosing iron deficiency is a \_\_\_\_\_\_\_ biopsy showing depleted iron stores.\ **Answer:** bone marrow **12. Which of the following conditions is characterized by microcytic hypochromic anemia?** - a\. Iron deficiency anemia - b\. Thalassemia - c\. Anemia of chronic disease - d\. All of the above\ **Answer:** d. All of the above **13. The main cause of iron deficiency in premenopausal women is:** - a\. Malabsorption - b\. Dietary deficiency - c\. Menstrual blood loss - d\. Chronic infection\ **Answer:** c. Menstrual blood loss **14. Which of the following foods is the richest source of heme iron?** - a\. Spinach - b\. Red meat - c\. Lentils - d\. Oranges\ **Answer:** b. Red meat **15. Iron absorption occurs mainly in the:** - a\. Stomach - b\. Duodenum - c\. Jejunum - d\. Ileum\ **Answer:** b. Duodenum **16. True/False (One for Each Option):** Regarding iron overload: - a\. Iron overload can lead to liver fibrosis. - b\. Hemosiderin is the primary storage form in iron overload. - c\. Serum ferritin is elevated in iron overload. - d\. Excess iron is excreted via the kidneys.\ **Answers:** - a\. True - b\. True - c\. True - d\. False **17. What is the most common genetic cause of primary iron overload?** - a\. Sickle cell disease - b\. Hemochromatosis (HFE gene mutation) - c\. Thalassemia major - d\. Myelodysplastic syndrome\ **Answer:** b. Hemochromatosis (HFE gene mutation) **18. Which test is most useful for differentiating iron deficiency anemia from anemia of chronic disease?** - a\. Serum ferritin - b\. Serum iron - c\. Total iron-binding capacity - d\. Transferrin saturation\ **Answer:** a. Serum ferritin **19. Fill-in-the-Blank:** In anemia of chronic disease, hepcidin levels are typically \_\_\_\_\_\_\_.\ **Answer:** elevated **20. All of the following are treatments for iron deficiency EXCEPT:** - a\. Oral ferrous sulfate - b\. Intravenous iron infusion - c\. Phlebotomy - d\. Dietary modification\ **Answer:** c. Phlebotomy 21. **True/False (One for Each Option): Regarding iron deficiency in children:** - a\. Iron deficiency is a common cause of developmental delay. - b\. Cow's milk is a rich source of bioavailable iron. - c\. Iron supplementation may cause transient gastrointestinal discomfort. - d\. Pica can develop in children with chronic iron deficiency.\ **Answers:** - a\. True - b\. False - c\. True - d\. True 22. Iron absorption is enhanced by which of the following dietary components? - a\. Phytates - b\. Tannins - c\. Vitamin C - d\. Calcium\ **Answer:** c. Vitamin C 23. All the following are true regarding heme iron EXCEPT: - a\. Found in animal-based foods - b\. Absorption depends on gastric acidity - c\. Absorbed faster than non-heme iron - d\. Its absorption is enhanced by phytic acid\ **Answer:** d. Its absorption is enhanced by phytic acid 24. **True/False (One for Each Option): Features of anemia of chronic disease (ACD):** - a\. ACD typically shows a low serum iron level. - b\. Serum ferritin is low in ACD. - c\. Hepcidin levels are often elevated. - d\. It is commonly associated with infections or autoimmune conditions.\ **Answers:** - a\. True - b\. False - c\. True - d\. True 25. Excessive iron intake can lead to: - a\. Hyperpigmented skin - b\. Hematologic toxicity - c\. Hepatic damage - d\. All of the above\ **Answer:** d. All of the above 26. Which laboratory test most accurately measures total body iron stores? - a\. Serum ferritin - b\. Serum iron - c\. Transferrin saturation - d\. Total iron-binding capacity (TIBC)\ **Answer:** a. Serum ferritin 27. The most appropriate treatment for hereditary hemochromatosis is: - a\. Oral chelators - b\. Phlebotomy - c\. Blood transfusions - d\. Vitamin C supplementation\ **Answer:** b. Phlebotomy 28. Iron deficiency anemia is characterized by all of the following laboratory findings EXCEPT: - a\. Decreased hematocrit - b\. Increased red blood cell distribution width (RDW) - c\. Macrocytosis - d\. Hypochromia\ **Answer:** c. Macrocytosis 29. Fill-in-the-Blank: A key difference between thalassemia and iron deficiency anemia is that \_\_\_\_\_\_\_ ferritin is observed in thalassemia.\ **Answer:** normal or elevated 30. Which of the following enzymes is disrupted by iron deficiency? - a\. Ferrochelatase - b\. Cytochrome c oxidase - c\. Catalase - d\. All of the above\ **Answer:** d. All of the above - Which laboratory finding is most specific for iron deficiency anemia?\ a. Decreased MCV\ b. Low serum ferritin\ c. Increased TIBC\ d. Low hemoglobin\ **Answer:** b. Low serum ferritin - Which cytokine upregulates hepcidin production in anemia of chronic disease?\ a. IL-1\ b. IL-6\ c. TNF-α\ d. IFN-γ\ **Answer:** b. IL-6 - Fill-in-the-Blank: The main transporter responsible for dietary iron absorption in enterocytes is \_\_\_\_\_\_\_.\ **Answer:** Divalent Metal Transporter 1 (DMT1) - True/False (One for Each Option): Regarding hepcidin regulation:\ a. Hypoxia decreases hepcidin synthesis.\ b. Hepcidin inhibits ferroportin activity.\ c. High iron stores stimulate hepcidin production.\ d. Erythropoiesis increases hepcidin levels.\ **Answers:**\ a. True\ b. True\ c. True\ d. False - What is the preferred method of diagnosing iron overload?\ a. Serum ferritin levels\ b. MRI for liver iron concentration\ c. Bone marrow biopsy\ d. Liver biopsy\ **Answer:** b. MRI for liver iron concentration - Which of the following is a classic symptom of iron overload?\ a. Pale conjunctiva\ b. Diabetes mellitus\ c. Glossitis\ d. Angular cheilitis\ **Answer:** b. Diabetes mellitus - The recommended daily iron intake for a non-pregnant adult woman is:\ a. 8 mg\ b. 15 mg\ c. 18 mg\ d. 25 mg\ **Answer:** c. 18 mg - Multiple Choice: In iron deficiency anemia, reticulocyte count is typically:\ a. Normal\ b. Low\ c. High\ **Answer:** b. Low - Which of the following describes the appearance of red blood cells in iron deficiency anemia?\ a. Macrocytic and hyperchromic\ b. Microcytic and hypochromic\ c. Normocytic and normochromic\ d. Macrocytic and hypochromic\ **Answer:** b. Microcytic and hypochromic - True/False: Iron absorption increases in response to chronic blood loss.\ **Answer:** True **41. True/False (One for Each Option):** Regarding folate metabolism: - a\. Folate is absorbed in the jejunum. - b\. Folate is required for DNA synthesis. - c\. Folate deficiency causes macrocytic anemia. - d\. Folate supplementation can mask B12 deficiency.\ **Answers:** - a\. True - b\. True - c\. True - d\. True **42. Vitamin B12 is absorbed in the:** - a\. Stomach - b\. Duodenum - c\. Ileum - d\. Jejunum\ **Answer:** c. Ileum **43. Which protein is essential for Vitamin B12 absorption?** - a\. Ferritin - b\. Intrinsic factor - c\. Transferrin - d\. Hepcidin\ **Answer:** b. Intrinsic factor **44. Pernicious anemia is caused by:** - a\. Vitamin C deficiency - b\. Folate deficiency - c\. Lack of intrinsic factor - d\. Iron deficiency\ **Answer:** c. Lack of intrinsic factor **45. All of the following are neurological manifestations of Vitamin B12 deficiency EXCEPT:** - a\. Peripheral neuropathy - b\. Spastic ataxia - c\. Dementia - d\. Optic neuritis\ **Answer:** d. Optic neuritis \... 41. **True/False (One for Each Option): Neurological manifestations of B12 deficiency:** - a\. Myelin synthesis is impaired. - b\. Manifestations are reversible with early treatment. - c\. Degeneration involves both motor and sensory nerves. - d\. Folate supplementation prevents these symptoms in all cases.\ **Answers:** - a\. True - b\. True - c\. True - d\. False 42. Which of the following lab results would confirm Vitamin B12 deficiency? - a\. Low mean corpuscular volume (MCV) - b\. Low methylmalonic acid (MMA) levels - c\. Elevated homocysteine levels - d\. Decreased serum folate levels\ **Answer:** c. Elevated homocysteine levels 43. What dietary source is rich in Vitamin B12? - a\. Dairy products - b\. Leafy greens - c\. Citrus fruits - d\. Legumes\ **Answer:** a. Dairy products 44. Pernicious anemia results from: - a\. Vitamin B12 destruction in the stomach - b\. Autoimmune destruction of gastric parietal cells - c\. Lack of adequate dietary folate - d\. Intestinal malabsorption of iron\ **Answer:** b. Autoimmune destruction of gastric parietal cells 45. Which of these populations is at the highest risk for folate deficiency? - a\. Pregnant women - b\. Men with iron overload - c\. Adolescents with excessive calcium intake - d\. Infants on formula\ **Answer:** a. Pregnant women 46. Fill-in-the-Blank: Folic acid deficiency leads to the accumulation of \_\_\_\_\_\_\_ in the body due to impaired DNA synthesis.\ **Answer:** Homocysteine 47. Which coenzyme form of Vitamin B12 is essential for DNA synthesis?\ a. Methylcobalamin\ b. Cyanocobalamin\ c. Adenosylcobalamin\ d. Hydroxocobalamin\ **Answer:** a. Methylcobalamin 48. What is the most common cause of folate deficiency worldwide?\ a. Poor dietary intake\ b. Alcoholism\ c. Malabsorption\ d. Increased metabolic demand\ **Answer:** a. Poor dietary intake 49. True/False (One for Each Option): Regarding Vitamin B12 metabolism:\ a. Vitamin B12 binds to haptocorrin in saliva.\ b. Intrinsic factor binds B12 in the stomach.\ c. B12 absorption requires the presence of calcium.\ d. Methylmalonic acid levels decrease in Vitamin B12 deficiency.\ **Answers:**\ a. True\ b. True\ c. True\ d. False 50. Pernicious anemia is associated with antibodies against:\ a. Intrinsic factor and parietal cells\ b. Hepcidin and transferrin\ c. DMT1 and ferroportin\ d. Transcobalamin\ **Answer:** a. Intrinsic factor and parietal cells 51. Which neurological symptom is strongly associated with Vitamin B12 deficiency?\ a. Spinal cord degeneration\ b. Peripheral neuropathy\ c. Optic neuritis\ d. Cerebellar ataxia\ **Answer:** a. Spinal cord degeneration 52. Fill-in-the-Blank: Elevated \_\_\_\_\_\_\_ levels are a hallmark biochemical finding in Vitamin B12 deficiency.\ **Answer:** Methylmalonic acid 53. Which anemia is caused by impaired folate metabolism due to methotrexate treatment?\ a. Megaloblastic anemia\ b. Aplastic anemia\ c. Sideroblastic anemia\ d. Hemolytic anemia\ **Answer:** a. Megaloblastic anemia 54. True/False: Neurological symptoms caused by Vitamin B12 deficiency are reversible if treated promptly.\ **Answer:** True 55. Which enzyme requires both folate and Vitamin B12 as cofactors for its activity?\ a. Methionine synthase\ b. Succinyl-CoA synthetase\ c. Ferrochelatase\ d. Transaminase\ **Answer:** a. Methionine synthase 56. All of the following are symptoms of folate deficiency EXCEPT:\ a. Glossitis\ b. Fatigue\ c. Peripheral neuropathy\ d. Depression\ **Answer:** c. Peripheral neuropathy 57. Fill-in-the-Blank: Folate supplementation is particularly critical during \_\_\_\_\_\_\_ to prevent neural tube defects.\ **Answer:** Pregnancy 58. Which of the following conditions increases folate demand?\ a. Chronic alcohol use\ b. Hemolytic anemia\ c. Pregnancy\ d. All of the above\ **Answer:** d. All of the above 59. What is the Schilling test used to diagnose?\ a. Folate deficiency\ b. Vitamin B12 deficiency\ c. Iron deficiency anemia\ d. Pernicious anemia\ **Answer:** d. Pernicious anemia 60. True/False: Folate deficiency commonly causes neuropathy.\ **Answer:** False 61. True/False: Both folate and Vitamin B12 deficiencies can lead to megaloblastic anemia.\ **Answer:** True 62. What distinguishes anemia caused by Vitamin B12 deficiency from folate deficiency?\ a. Macrocytosis\ b. Neurological symptoms\ c. Glossitis\ d. Elevated homocysteine\ **Answer:** b. Neurological symptoms 63. Fill-in-the-Blank: Elevated homocysteine and normal methylmalonic acid levels suggest \_\_\_\_\_\_\_ deficiency.\ **Answer:** Folate 64. Which of the following is most likely to cause iron and Vitamin B12 deficiencies simultaneously?\ a. Vegetarian diet\ b. Gastric bypass surgery\ c. Chronic kidney disease\ d. Crohn\'s disease\ **Answer:** b. Gastric bypass surgery 65. All of the following are causes of combined folate and Vitamin B12 deficiency EXCEPT:\ a. Alcoholism\ b. Malabsorption\ c. Vegan diet\ d. Hemochromatosis\ **Answer:** d. Hemochromatosis 21\. What is the role of ferroportin in iron metabolism?\ a. Exports iron from enterocytes into the bloodstream\ b. Converts ferric iron (Fe³⁺) into ferrous iron (Fe²⁺)\ c. Binds iron to transferrin in plasma\ d. Stores iron intracellularly\ **Answer**: a. Exports iron from enterocytes into the bloodstream 22. Which of the following is NOT a common cause of iron deficiency anemia?\ a. Hookworm infestation\ b. Celiac disease\ c. Chronic kidney disease\ d. Chronic gastrointestinal blood loss\ **Answer**: c. Chronic kidney disease 23. Fill-in-the-Blank: \_\_\_\_\_\_ is the hormone produced by the liver that regulates systemic iron homeostasis by inhibiting ferroportin activity.\ **Answer**: Hepcidin 24. What laboratory finding is typically elevated in anemia of chronic disease but not in iron deficiency anemia?\ a. Serum ferritin\ b. Serum iron\ c. Hemoglobin\ d. Transferrin saturation\ **Answer**: a. Serum ferritin 25. True/False: Severe iron overload can cause hypogonadism and diabetes mellitus due to organ damage.\ **Answer**: True 26. Which stain is most commonly used to detect iron in bone marrow samples?\ a. Periodic acid-Schiff\ b. Perl\'s Prussian blue\ c. Giemsa\ d. Wright\'s\ **Answer**: b. Perl\'s Prussian blue 27. In hemochromatosis, iron overload primarily affects which of the following organs?\ a. Kidneys\ b. Spleen\ c. Liver\ d. Pancreas\ **Answer**: c. Liver 28. Match the laboratory findings to their condition (Iron Deficiency Anemia vs. Anemia of Chronic Disease):\ a. High TIBC: \_\_\_\_\_\_\ b. Elevated ferritin: \_\_\_\_\_\_\ c. Low transferrin saturation: \_\_\_\_\_\_\ d. Increased hepcidin: \_\_\_\_\_\_\ **Answers**:\ a. High TIBC: Iron Deficiency Anemia\ b. Elevated ferritin: Anemia of Chronic Disease\ c. Low transferrin saturation: Both\ d. Increased hepcidin: Anemia of Chronic Disease 29. Which of the following iron supplements is most commonly prescribed for iron deficiency anemia?\ a. Ferrous fumarate\ b. Ferrous sulfate\ c. Ferrous gluconate\ d. All of the above\ **Answer**: d. All of the above 30. Which blood disorder is associated with both ineffective erythropoiesis and systemic iron overload?\ a. Sideroblastic anemia\ b. Megaloblastic anemia\ c. Aplastic anemia\ d. Hemolytic anemia\ **Answer**: a. Sideroblastic anemia 46. True/False: Excess folic acid supplementation can reverse neurological symptoms of Vitamin B12 deficiency.\ **Answer**: False 47. Fill-in-the-Blank: Megaloblastic anemia caused by folate deficiency can develop within \_\_\_\_\_\_ (weeks/months) of inadequate dietary intake.\ **Answer**: Weeks 48. What is the primary dietary source of Vitamin B12?\ a. Leafy green vegetables\ b. Whole grains\ c. Dairy products and meat\ d. Fruits\ **Answer**: c. Dairy products and meat 49. Which enzyme requires Vitamin B12 as a cofactor?\ a. Methionine synthase\ b. Dihydrofolate reductase\ c. Transferrin reductase\ d. Ferrochelatase\ **Answer**: a. Methionine synthase 50. What is the most likely finding in the blood smear of a patient with megaloblastic anemia?\ a. Microcytic hypochromic cells\ b. Macrocytic hyperchromic cells\ c. Sickle-shaped cells\ d. Target cells\ **Answer**: b. Macrocytic hyperchromic cells 51. Which of the following statements about intrinsic factor is TRUE?\ a. It is secreted by the chief cells of the stomach.\ b. It binds Vitamin B12 in the stomach.\ c. It is necessary for Vitamin B12 release from food.\ d. Its absence leads to folate deficiency.\ **Answer**: b. It binds Vitamin B12 in the stomach. 52. Pernicious anemia is associated with autoantibodies targeting which structures?\ a. Parietal cells and intrinsic factor\ b. Jejunal enterocytes\ c. Duodenal goblet cells\ d. Hepatic Kupffer cells\ **Answer**: a. Parietal cells and intrinsic factor 53. True/False: Folate deficiency in pregnant women is associated with neural tube defects in the fetus.\ **Answer**: True 54. What distinguishes Vitamin B12 deficiency from folate deficiency clinically?\ a. Presence of neurological symptoms\ b. Presence of macrocytic anemia\ c. Fatigue\ d. Low reticulocyte count\ **Answer**: a. Presence of neurological symptoms 55. Fill-in-the-Blank: Vitamin B12 is required for the conversion of methylmalonyl-CoA to \_\_\_\_\_\_.\ **Answer**: Succinyl-CoA 56. What is the Schilling test used to diagnose?\ a. Intrinsic factor deficiency\ b. Iron deficiency\ c. Folate deficiency\ d. Hemochromatosis\ **Answer**: a. Intrinsic factor deficiency 57. Which laboratory parameter is elevated in both Vitamin B12 and folate deficiencies?\ a. Homocysteine\ b. Methylmalonic acid\ c. Serum iron\ d. Hepcidin\ **Answer**: a. Homocysteine 58. A 60-year-old patient presents with macrocytic anemia and a sore tongue. Blood tests show elevated homocysteine and methylmalonic acid. What is the most likely diagnosis?\ a. Folate deficiency anemia\ b. Vitamin B12 deficiency anemia\ c. Iron deficiency anemia\ d. Sideroblastic anemia\ **Answer**: b. Vitamin B12 deficiency anemia 59. True/False: Chronic alcoholism is a common cause of folate deficiency.\ **Answer**: True 60. Fill-in-the-Blank: The earliest sign of folate deficiency is a decrease in \_\_\_\_\_\_\_\_.\ **Answer**: Serum folate levels