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WorksheetsAnemia in Chronic Kidney Disease Quiz
Total questions: 30
Worksheet time: 30mins
A 62-year-old man with CKD stage 4 presents with progressive fatigue and dyspnea on exertion. His hemoglobin is 9.2 g/dL, MCV 90 fL, ferritin 450 ng/mL, TSAT 30%, and reticulocyte count low. What is the most likely cause of his anemia?
Iron deficiency anemia
Erythropoietin deficiency
Hemolysis due to uremia
Anemia of chronic inflammation
A 65-year-old CKD stage 5 patient has a hemoglobin of 8.5 g/dL. His reticulocyte count is low, ferritin is 400 ng/mL, and TSAT is 30%. What does the low reticulocyte count indicate?
Ongoing hemolysis
Bone marrow suppression
Iron-restricted erythropoiesis
Vitamin B12 deficiency
A 70-year-old CKD stage 5 patient has a hemoglobin of 9.0 g/dL, ferritin 800 ng/mL, and TSAT 18%. What is the most likely cause of his anemia?
Absolute iron deficiency
Functional iron deficiency
Hemoglobinopathy
ESA resistance
A 55-year-old CKD stage 4 patient has hemoglobin 9.5 g/dL, MCV 105 fL, and B12 levels normal. What is the most likely cause of macrocytosis?
CKD-related anemia
Folate deficiency
Uremic toxicity
Hemolysis
A 65-year-old woman with CKD stage 4 has hemoglobin 8.8 g/dL and high RDW. What does an elevated RDW suggest?
Early iron deficiency
Pure Red Cell Aplasia
Myelodysplastic syndrome
Beta-thalassemia minor
A dialysis patient has persistent anemia despite adequate iron and ESA therapy. Which uremic toxin most contributes to erythropoietin resistance?
Indoxyl sulfate
Urea
Creatinine
Homocysteine
A CKD stage 5 patient on ESA therapy has persistent anemia and elevated CRP. What is the most likely cause of ESA resistance?
Functional iron deficiency
Hypothyroidism
Bone marrow failure
Hyperparathyroidism
A dialysis patient has worsening anemia despite adequate ESA therapy. His labs show MCV of 97, Ferritin of 450 ng/ml, Tsats of 35%, Normal Vitamin B12 and RBC Folate levels, and Intact PTH of 1100 IU/L. What is the best next step?
Increase ESA dose
Check bone marrow biopsy
Treat secondary hyperparathyroidism
Start blood transfusions
A CKD stage 4 patient on ESA therapy has hemoglobin 13.5 g/dL. What should be done next?
Continue current ESA dose
Reduce ESA dose
Increase ESA dose
Check ferritin and TSAT
A dialysis patient on ESA therapy for 6 months develops sudden worsening anemia (Hb 6.5 g/dL) with very low reticulocyte count. What is the most likely diagnosis?
Functional iron deficiency
ESA-induced pure red cell aplasia
Myelofibrosis
Hemolysis
A 65-year-old patient with CKD stage 4 has Hb 9.8 g/dL, TSAT 30%, ferritin 350 ng/mL, and no active bleeding. He has mild fatigue but is otherwise asymptomatic. What is the most appropriate next step in managing his anemia?
Start erythropoiesis-stimulating agent (ESA)
Start IV iron therapy
Observe and reassess in 3 months
Transfuse 1 unit of packed RBCs
A 72-year-old woman with CKD stage 5 on ESA therapy has Hb 12.5 g/dL. She has no symptoms of anemia. What is the most appropriate management?
Continue current ESA dose
Increase ESA dose
Reduce ESA dose
Check iron levels and continue therapy
A 60-year-old CKD stage 3 patient has Hb 9.2 g/dL, TSAT 17%, and ferritin 80 ng/mL. What is the best next step in managing his anemia?
Start oral iron therapy
Start IV iron therapy
Start ESA therapy
Start blood transfusion
A 67-year-old dialysis patient on ESA therapy has Hb 9.0 g/dL despite escalating ESA doses. His ferritin is 900 ng/mL, TSAT 22%, and CRP is elevated. What is the most likely cause of his ESA resistance?
Functional iron deficiency
Vitamin B12 deficiency
Hemolysis
Bone marrow failure
A CKD stage 5 patient on ESA therapy has Hb 13.5 g/dL and complains of new-onset headaches and hypertension. What is the most likely cause?
ESA-induced hypertension
Polycythemia vera
Hyperviscosity syndrome
Uremic encephalopathy
A 74-year-old CKD stage 5 patient with coronary artery disease has Hb 6.9 g/dL and is dyspneic at rest. What is the best next step?
Increase ESA dose
IV iron therapy
Blood transfusion
Start darbepoetin
A dialysis patient on ESA therapy has Hb 9.5 g/dL, TSAT 15%, and ferritin 600 ng/mL. What is the best management?
Continue current therapy
Start IV iron
Increase ESA dose
Stop ESA therapy
A CKD stage 4 patient on ESA therapy has Hb 8.8 g/dL, ferritin 500 ng/mL, TSAT 25%, and PTH 1200 pg/mL. What is the best management?
Increase ESA dose
Start IV iron
Treat hyperpar
A CKD stage 4 patient on IV iron has ferritin 900 ng/mL and TSAT 35%. What should be done next?
Continue IV iron
Reduce iron dose
Stop IV iron
Start ESA
A CKD stage 5 patient requires ESA therapy however has a distaste for injections and has requested you for fewer injections. Which ESA is the obvious choice?
Epoetin alfa
Darbepoetin alfa
PEG-epoetin beta
Recombinant human EPO
A 58-year-old male with CKD stage 4 (eGFR 20 mL/min/1.73 m²) presents with fatigue and pallor. His hemoglobin level is 9.2 g/dL, serum ferritin is 120 ng/mL, and transferrin saturation (TSAT) is 20%. What is the most appropriate next step in managing this patient's anemia?
Start erythropoiesis-stimulating agent (ESA) therapy immediately
Administer intravenous (IV) iron therapy
Prescribe oral iron supplementation
Initiate a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI)
A 65-year-old female with DM, CAD and CKD stage 5 on hemodialysis has been receiving epoetin alfa for anemia. Her hemoglobin rises from 9.8 g/dL to 11.5 g/dL over 4 weeks. What is the most appropriate action regarding her ESA dose?
Increase the ESA dose to achieve a target hemoglobin of 12 g/dL
Maintain the current ESA dose and monitor hemoglobin weekly
Reduce the ESA dose.
Discontinue ESA therapy.
A 70-year-old male with CKD stage 3b (eGFR 40 mL/min/1.73 m²) has anemia with hemoglobin 9.8 g/dL, ferritin 350 ng/mL, and TSAT 30%. What is the most appropriate initial treatment for this patient's anemia?
Oral iron supplementation
Intravenous iron therapy
Erythropoiesis-stimulating agent (ESA) therapy
Observation without intervention
A 50-year-old female with CKD stage 5 on peritoneal dialysis has persistent anemia despite ESA therapy. Her ferritin is 800 ng/mL, TSAT is 30%, and CRP is elevated at 25 mg/L. What is the most likely cause of ESA resistance in this patient?
Iron deficiency
Inflammation
Vitamin B12 deficiency
Aluminum toxicity
A 62-year-old male with CKD stage 4 (eGFR 25 mL/min/1.73 m²) is started on oral iron for anemia. After 3 months, his hemoglobin remains low at 9.5 g/dL, ferritin is 150 ng/mL, and TSAT is 18%. What is the most appropriate next step in management?
Continue oral iron for another 3 months
Switch to intravenous iron therapy
Initiate ESA therapy immediately
Evaluate for gastrointestinal bleeding
A 75-year-old female with CKD stage 5 on hemodialysis develops iron overload with ferritin levels >1000 ng/mL. She continues to require ESA therapy for anemia. What is the most appropriate management strategy?
Discontinue iron therapy and monitor ferritin monthly
Reduce IV Iron dose
Initiate phlebotomy to reduce iron stores
Switch to a higher ESA dose.
A 55-year-old male with CKD stage 3b (eGFR 35 mL/min/1.73 m²) has anemia with hemoglobin 9.8 g/dL, ferritin 50 ng/mL, and TSAT 15%. He declines blood transfusions due to religious beliefs. What is the most appropriate treatment option?
High-dose oral iron therapy
Intravenous iron therapy
Initiation of ESA therapy
Dietary counseling
A 60-year-old female with CKD stage 5 on hemodialysis is prescribed roxadustat for anemia. Her hemoglobin increases from 9.0 g/dL to 11.0 g/dL over 6 weeks. What is the mechanism of action of roxadustat?
Stimulates erythropoietin production in the liver
Increases iron absorption in the gut
Stabilizes hypoxia-inducible factor (HIF) to enhance erythropoiesis
Directly stimulates red blood cell production in the bone marrow
A 68-year-old male with CKD stage 4 (eGFR 22 mL/min/1.73 m²) has anemia with hemoglobin 8.5 g/dL, ferritin 250 ng/mL, and TSAT 22%. He is initiated on darbepoetin alfa. What is the most important parameter to monitor during ESA therapy?
S / vitamin B12 biweekly
Hemoglobin levels biweekly.
Platelet count weekly
Liver function tests biweekly
A 52-year-old female with CKD stage 5 on hemodialysis has refractory anemia despite ESA therapy and adequate iron stores. Her parathyroid hormone (PTH) level is 1200 pg/mL. What is the most likely contributing factor to her refractory anemia?
Vitamin D deficiency
Secondary hyperparathyroidism
Folate deficiency
Aluminum toxicity
