new_n_lost
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A 54-year-old white man is admitted to the hospital because of abdominal pain and "black stools." He has not seen a doctor in years. He smokes two packs of cigarettes daily. Physical exam reveals poor dentition, normal cardiovascular exam, moderate splenomegaly with mild epigastric and left upper quadrant tenderness, and a guaiac stool test positive for occult blood. Laboratory values reveal a hemoglobin of 9.5 g/dL, hematocrit of 29%, WBC count of 14,500/μL with a fairly normal differential, a platelet count of 540,000/μL, and a ferritin level of 4 μg/L. Serum vitamin B12 levels are elevated. A bone marrow exam shows hypercellularity without other specific findings, and chromosomes are reported as normal. Endoscopy reveals a gastric ulcer and biopsies are negative for malignancy but positive for Helicobacter pylori infection. Appropriate management at this stage should be
A) Splenectomy
B) Transfusion of two units of packed RBCs
C) Observation
D) Antibiotic treatment for the H. pylori infection and iron supplementation for the iron deficiency anemia
E) Antibiotic treatment for the H. pylori infection
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| usmle4me
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E
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| girl^interrupted
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E. The only thing you can do at this time is treat the ulcer
Is it polycythemia????? and he might b deficient in Iron b/c of the bleeding ulcer...That will explain the high level of platelets n low hematocrit.... So I'll assume phlebotomy t/m was not done b/c that way all the cells would have been lower...
I knw its too wild a thinking but no harm in assuming....
plz do let us knw the right ans n xplanation..
plus I think its too much of medicine n less step-1 stuff...... (
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| rock
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D ?
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| new_n_lost
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GOOD JOB Girl ^ Interrupted Excellent Diagnosis!!!!!
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
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Answer: E
Explanation: Recognize that this patient has all of the manifestations of Polycythemia Rubra Vera except that his bleeding gastric ulcer has masked the development of Polycythemia. Because of his bleeding gastric ulcer, he has already become iron deficient, which is the goal of the cornerstone phlebotomy therapy for Polycythemia Vera. Instituting iron supplementation at this point may very well give the patient more morbidity because it could cause a rebound erythrocytosis.
Rather, the H. pylori infection should be treated to cure the gastric ulcer, and a further work-up for a probable diagnosis of Polycythemia Vera should ensue, including culture of the patient's erythroid progenitor cells looking for EPO-independent colony growth, a hallmark for the diagnosis of Polycythemia Vera.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| nandrolone
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superb.
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| rock
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wow...good question.
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