A 30-year-old woman with heavy menstrual bleeding has fatigue, pallor, and ice cravings. Labs: Hb 9.0 g/dL (↓), MCV 72 fL (↓), serum iron 30 mcg/dL (↓), TIBC 480 mcg/dL (↑), ferritin 8 ng/mL (↓).
Question: What is the most likely diagnosis?
Question: What is the most likely diagnosis?
Anonymous Quiz
16%
A) Anemia of chronic disease
71%
B) Iron deficiency anemia
6%
C) Thalassemia
6%
D) Hemochromatosis
A 60-year-old man with rheumatoid arthritis and elevated CRP has Hb 10.5 g/dL (↓), MCV 85 fL, serum iron 40 mcg/dL (↓), TIBC 250 mcg/dL (↓), ferritin 350 ng/mL (↑).
Question: Why is TIBC low?
Question: Why is TIBC low?
Anonymous Quiz
19%
A) Iron overload
60%
B) Chronic inflammation
13%
C) Hemolysis
8%
D) Vitamin B12 deficiency
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A 45-year-old with Crohn’s disease and GI bleeding has Hb 8.5 g/dL (↓), MCV 78 fL (↓), serum iron 25 mcg/dL (↓), TIBC 400 mcg/dL (↑), ferritin 120 ng/mL (↑), CRP 50 mg/L (↑).
Question: Which test confirms iron deficiency?
Question: Which test confirms iron deficiency?
Anonymous Quiz
18%
A) Serum iron
53%
B) Soluble transferrin receptor (sTfR)
21%
C) TIBC
9%
D) CRP
A 12-year-old boy with lifelong microcytic anemia unresponsive to oral iron has Hb 8.8 g/dL (↓), MCV 68 fL (↓), serum iron 20 mcg/dL (↓), TIBC 500 mcg/dL (↑), ferritin 15 ng/m
Anonymous Quiz
25%
A)IDA
31%
B)ACD
26%
C)IRIDA
18%
D)Hemochromatosis
A child with microcytic anemia unresponsive to oral iron has serum iron 25 mcg/dL (↓), TIBC 480 mcg/dL (↑), ferritin 20 ng/mL (↓), ↑ hepcidin.
Question: Why is oral iron ineffective?
Question: Why is oral iron ineffective?
Anonymous Quiz
17%
A) Gut malabsorption
56%
B) Hepcidin excess
24%
C) Vitamin C deficiency
3%
D) Hemolysis
A 10-year-old child with lifelong microcytic anemia unresponsive to oral iron has:
Serum Iron: 18 µg/dL (Low) TIBC: 450 µg/dL (Normal) TSAT: 4% (Very Low) Ferritin: 50 µg/L (Normal) MCV: 68 fL (Low) Question: What disorder is suspected?
Serum Iron: 18 µg/dL (Low) TIBC: 450 µg/dL (Normal) TSAT: 4% (Very Low) Ferritin: 50 µg/L (Normal) MCV: 68 fL (Low) Question: What disorder is suspected?
Anonymous Quiz
12%
A) ACD
40%
B) IRIDA
33%
C) Thalassemia
15%
D) Hemochromatosis
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Case: A 30-year-old woman with menorrhagia has fatigue and pallor. Labs:
Hb: 8.8 g/dL (↓) MCV: 70 fL (↓) Serum Iron: 20 µg/dL (↓) TIBC: 500 µg/dL (↑) Ferritin: 12 µg/L (↓) Question: Which parameter confirms IDA?
Hb: 8.8 g/dL (↓) MCV: 70 fL (↓) Serum Iron: 20 µg/dL (↓) TIBC: 500 µg/dL (↑) Ferritin: 12 µg/L (↓) Question: Which parameter confirms IDA?
Anonymous Quiz
29%
A) High TIBC
51%
B) Low Ferritin
17%
C) Elevated CRP
3%
D) Normal MCV
Which lab pattern is typical of IRIDA?
Anonymous Quiz
38%
A) ↓ Serum Iron, ↑ TIBC, ↓ Ferritin
35%
B) ↓ Serum Iron, Normal TIBC, Normal Ferritin
13%
C) ↑ Serum Iron, ↓ TIBC, ↑ Ferritin
14%
D) ↓ Serum Iron, ↓ TIBC, ↑ Ferritin
Case: A patient with IRIDA has:
MCV: 65 fL (↓) Ferritin: 60 µg/L (normal) TSAT: 5% (↓↓) Question: Why is the MCV low?
MCV: 65 fL (↓) Ferritin: 60 µg/L (normal) TSAT: 5% (↓↓) Question: Why is the MCV low?
Anonymous Quiz
19%
A) Vitamin B12 deficiency
68%
B) Microcytic anemia due to iron deficiency
7%
C) Hemolysis
5%
D) Chronic inflammation
Question: Which condition is associated with low TIBC?
Anonymous Quiz
26%
A) IDA
27%
B) ACD
14%
C) IRIDA
33%
D) Thalassemia
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What does a low ACTH level with high cortisol indicate in the ACTH test?
Anonymous Quiz
20%
A) Pituitary problem
16%
B) Addison’s disease
56%
C) Adrenal problem (ACTH-independent)
7%
D) CRH overproduction
Which of the following is one of the confirmatory tests for Cushing’s syndrome?
Anonymous Quiz
50%
A) Single morning cortisol test
15%
B) Random cortisol measurement
26%
C) Late-night salivary cortisol x2
8%
D) Post-meal glucose test
Which of the following is a common skin manifestation in Cushing’s syndrome?
Anonymous Quiz
18%
A) Hypopigmentation
12%
B) Viral rash
54%
C) Skin atrophy with purple striae
16%
D) Night sweats
What is the mechanism behind hypertension in Cushing’s syndrome?
Anonymous Quiz
18%
A) Low renin secretion
15%
B) Increased catecholamines
60%
C) Cortisol acting on mineralocorticoid receptors
7%
D) High levels of insulin
What is the reason for hyperglycemia in patients with Cushing’s syndrome?
Anonymous Quiz
10%
A) Increased insulin secretion
8%
B) Glucose loss in urine
75%
C) Insulin resistance due to cortisol
8%
D) Decreased glucagon levels
Which of the following symptoms is NOT typically seen in Cushing’s syndrome?
Anonymous Quiz
12%
A) Truncal obesity
62%
B) Hypoglycemia
13%
C) Osteoporosis
14%
D) Hirsutism
Which of the following lab findings supports a diagnosis of Cushing's syndrome?
Anonymous Quiz
19%
A) Morning serum cortisol < 1.8 µg/dL
39%
B) 24h urinary free cortisol > 50 µg/day
19%
C) ACTH > 200 pg/m
9%
C) ACTH > 200 pg/mL
15%
D) Midnight salivary cortisol < 0.18 µg/dL
A patient with Cushing’s syndrome presents with proximal muscle weakness and easy bruising. What is the most likely mechanism?
Anonymous Quiz
16%
A) Hypercalcemia and vasculitis
22%
B) Increased insulin sensitivity
47%
C) Protein catabolism and capillary fragility
16%
D) Autoimmune vasculitis
Which of the following best explains hypertension in Cushing’s syndrome?
Anonymous Quiz
8%
A) Renin deficiency
23%
B) Increased aldosterone from the adrenal cortex
63%
C) Cortisol acting like aldosterone at mineralocorticoid receptors
6%
D) Increased vagal tone
A 37-year-old woman presents with complaints of weight gain, muscle weakness, and irregular menstrual periods. On physical exam, she has truncal obesity, facial rounding, purple abdominal striae, and proximal muscle wasting. Her blood pressure is 155/100 mmHg.
She is not taking any steroids.
Laboratory Results:
8 AM serum cortisol: 28 µg/dL (5–25 µg/dL)
Midnight salivary cortisol: 0.3 µg/dL (<0.18 µg/dL)
24-hour urinary free cortisol: 300 µg/day (20–90 µg/day)
Serum ACTH: 85 pg/mL (10–60 pg/mL)
High-dose dexamethasone suppression test: Cortisol suppressed by 60%
CRH stimulation test: ACTH increases >50%, cortisol rises
She is not taking any steroids.
Laboratory Results:
8 AM serum cortisol: 28 µg/dL (5–25 µg/dL)
Midnight salivary cortisol: 0.3 µg/dL (<0.18 µg/dL)
24-hour urinary free cortisol: 300 µg/day (20–90 µg/day)
Serum ACTH: 85 pg/mL (10–60 pg/mL)
High-dose dexamethasone suppression test: Cortisol suppressed by 60%
CRH stimulation test: ACTH increases >50%, cortisol rises
What is the most likely cause of this patient’s Cushing syndrome above?
Anonymous Quiz
29%
A) Adrenal adenoma
17%
B) Ectopic ACTH-producing tumor
46%
C) Pituitary adenoma (Cushing disease)
8%
D) Exogenous steroid use
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