jonathon
Forum Senior
Topics: 25
Posts: 62
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A 44-year-old man has had no major medical problems throughout his life, except for arthritis pain involving all extremities for the past 5 years. He has had worsening orthopnea and pedal edema in the past 6 months. There is no chest pain. On examination he is afebrile. A chest radiograph shows cardiomegaly with both enlarged left and right heart borders, along with pulmonary edema. Laboratory studies show serum sodium 139 mmol/L, potassium 4.3 mmol/L, chloride 99 mmol/L, CO2 25 mmol/L, urea nitrogen 18 mg/dL, creatinine 1.3 mg/dL, and glucose 167 mg/dL. Which of the following additional laboratory test findings is he most likely to have?
A Spherocytes on his peripheral blood smear
B Hemoglobin of 10.7 g/dL with MCV of 72 fL
C Erythrocyte sedimentation rate of 79 mm/Hr
D Anti-centromere antibody titer of 1:320
E Serum ferritin of 8700 ng/mL
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| vemi007
Forum Senior
Topics: 36
Posts: 74
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the ans is B. Is it right?
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| jonathon
Forum Senior
Topics: 25
Posts: 62
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Answer is E. He has findings of a cardiomyopathy with right and left heart failure. Hereditary hemochromatosis can produce iron deposition in visceral organs, including the heart. The serum ferritin is a good indicator of body iron stores. Hemochromatosis affects the pancreas as well, leading to diabetes mellitus. Deposition of iron in joints leads to arthritis. The onset of disease is typically in the 40's in males and 60's in females. This one is tough....,but B was a good attempt
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| sturge_weber
Forum Guru
Topics: 77
Posts: 1,042
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good question joan
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| Geroo
Forum Guru
Topics: 114
Posts: 799
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good question jonathon,where is it from?
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| jonathon
Forum Senior
Topics: 25
Posts: 62
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Either from Qbook or some path site on the net, cant remember where in my notes i copied it from..
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| robin082006
Forum Hero
Topics: 471
Posts: 5,123
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This question is really hard because we do not have enough clear evidence for hemochromatosis (classic triad: micronodular cirrhosis, pancreatic fibrosis, and skin pigmentation).
Thanks for posting this question.
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