Scenario 2
Mr L is a 16-year-old boy who up until recently, was physically active with no known medical issues. Three years ago, the family became passionate about animal welfare and commenced a vegan diet. Lately Mr L has become irritable and lethargic, is finding it hard to concentrate at school and is too tired to take part in his weekly sporting events. While Mr L has gone through puberty, he has not had his final growth spurt and is short for his age. Mr L’s mother read on the internet that increasing zinc intakes can help with growth and has been supplementing him daily with 4 times the recommended dietary intake (RDI).
His mother is concerned with his change in energy levels, and takes him to the doctor’s for a check-up. The doctor prescribes a series of blood tests and the results are outlined in Table A.

Table A. Mr L’s Blood Test Results

Parameter Patients Result Normal Range
White Blood Cells 6.0 4.5-11.0 109/L
Haemoglobin 108 120-150 g/L
Serum Iron 43 50-170 mcg/dL
% Transferrin Saturation 15 20-38 %
Ferritin 6 10-300 ng/mL

Questions: Select the most appropriate answer for each of the blanks.

Mr L's blood test results show that he is suffering from
[ Select ]
iron overload
increased iron transport
iron deficiency anaemia
the early stages of iron deficiency
. (1 mark)

Mr L's low iron levels are most likely a result of all the following EXCEPT
[ Select ]
reduced absorption
increased body needs
inadequate dietary intake
chronic blood loss
. (1 mark)

Question

Scenario 2
Mr L is a 16-year-old boy who up until recently, was physically active with no known medical issues. Three years ago, the family became passionate about animal welfare and commenced a vegan diet. Lately Mr L has become irritable and lethargic, is finding it hard to concentrate at school and is too tired to take part in his weekly sporting events. While Mr L has gone through puberty, he has not had his final growth spurt and is short for his age. Mr L’s mother read on the internet that increasing zinc intakes can help with growth and has been supplementing him daily with 4 times the recommended dietary intake (RDI).
His mother is concerned with his change in energy levels, and takes him to the doctor’s for a check-up.  The doctor prescribes a series of blood tests and the results are outlined in Table A.

Table A. Mr L’s Blood Test Results

Parameter	Patients Result	Normal Range
  White Blood Cells	6.0	4.5-11.0 109/L
  Haemoglobin	108	120-150 g/L
  Serum Iron	43	50-170 mcg/dL
  % Transferrin Saturation	15	20-38 %
  Ferritin	6	10-300 ng/mL

Questions:  Select the most appropriate answer for each of the blanks.

Mr L's blood test results show that he is suffering from 
[ Select ]
iron overload
increased iron transport
iron deficiency anaemia
the early stages of iron deficiency
 .   (1 mark)
 
Mr L's low iron levels are most likely a result of all the following EXCEPT 
[ Select ]
reduced absorption
increased body needs
inadequate dietary intake
chronic blood loss
 .   (1 mark)

BlackTom AI · Accepted Answer

Statement restatement and option analysis:

First blank: Mr L's blood test results show low Hb (108 g/L), low serum iron (43 mcg/dL), low transferrin saturation (15%), and very low ferritin (6 ng/mL). These findings collectively indicate iron deficiency rather than iron overload or any other disturbance. 
- Option: iron deficiency anaemia — This is the correct interpretation because one hallmark of iron deficiency is reduced ferritin along with low serum iron and low transferrin saturation, accompanied by a low Hb. The combination of iron metrics points to anaemia caused by iron deficiency. 
- Option: iron overload — This would present with high serum iron and ferritin, not the low values seen here, so it is inconsistent with the data. 
- Option: increased iron transport — Transferrin saturation is low (15%), not increased, so this option contradicts the lab pattern. 
- Option: the early stages of iron deficiency — While some features like low ferritin can mark early deficiency, the Hb is already low and ferritin is very low, suggesting established iron deficiency rather than only an early stage. Overall, the lab profile strongly supports iron deficiency anaemia rather than the other choices.

Second blank: The question asks for the statement that is NOT a likely cause of Mr L's low iron. The context includes a vegan diet and rapid growth during adolescence, with signs of iron deficiency. 
- Option: reduced absorption — Vegan diets can reduce iron absorption due to non-heme iron and phytates; this is a plausible contributor to iron deficiency. Thus this option supports a cause, not an exception. 
- Option: increased body needs — During adolescence, especially with pubertal growth spurts, iron requirements rise. This increased need is a recognized contributor to iron deficiency, so it is not the exception. 
- Option: inadequate dietary intake — A plant-based diet without attention to iron-rich foods can lead to insufficient iron intake; this is a valid cause, not the exception. 
- Option: chronic blood loss — While chronic blood loss can cause iron deficiency in some patients, the case here provides no evidence of a bleeding source (e.g., GI bleed, heavy menses is not applicable to a 16-year-old male). In the exam context, this option is the least likely given the information, making it the exception. Therefore, chronic blood loss is identified as the statement that is least likely to be the cause among the listed possibilities.

Summary of reasoning for each option:
- First blank, iron deficiency anaemia: consistent with low Hb, low serum iron, low transferrin saturation, and very low ferritin; explanation anchored in standard iron-deficiency physiology. 
- First blank, iron overload: inconsistent with the observed iron metrics; therefore incorrect. 
- First blank, increased iron transport: inconsistent with a low transferrin saturation; therefore incorrect. 
- First blank, the early stages of iron deficiency: while ferritin could be low early, the presence of anaemia (low Hb) supports a more established deficiency rather than an early stage; therefore less fitting. 
- Second blank, reduced absorption: plausible given vegan diet and iron bioavailability; not the exception. 
- Second blank, increased body needs: adolescence growth increases needs; not the exception. 
- Second blank, inadequate dietary intake: fits with vegan diet concerns; not the exception. 
- Second blank, chronic blood loss: while a possible cause in many contexts, there is no evidence of bleeding in this vignette, making this the exception among the listed options.

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