NBME Form 1

Prep for USMLE Forum

» Log in | Register

Forum

Step 1

Match

Prep4USMLE Forum » USMLE Step 1 Forum » Pathology Forum

NBME Form 1

Author

10 Posts

macintosh
Forum Elite

Topics: 38
Posts: 178

04/14/08 - 04:17 AM

A 32-year-old man has had malaise, a low-grade fever, and a 4.5-kg (10-lb) weight loss over the past 3 months. He has unilateral cervical lymph adenopathy. Laboratory studies show:

Hemoglobin 11g/dl
Hematocrit 33%
Mean corpuscular volume 80 um3
Reticulocyte count 0.5%
Serum iron 25 ug/dl
Total iron-binding capacity 150ug/dl (N=250-460)

Examination of tissue obtained on biopsy of a lymph node shows Hodgkin's disease, nodular sclerosing type. The most likely cause of the anemia is
A) abnormal utilization of iron
B) extravascular hemolysis
C) folate deficiency
D) iron deficiency
E) marrow aplasia

macintosh
Forum Elite

Topics: 38
Posts: 178

04/14/08 - 04:24 AM

Do not just pick a choice, please post your explanation.

macintosh
Forum Elite

Topics: 38
Posts: 178

04/14/08 - 04:44 AM

The likely answer is choice A) abnormal utilization of iron. However I do not understand why Hodgkin's disease should cause anemia of the chronic disease. Please some one explain.

new_n_lost
Politically InCorrect
avatar

Topics: 653
Posts: 6,075

04/14/08 - 05:11 AM

First of all the WHole of the form is already discussed in the Path section so be sure to post the ones which you think not sure abt.

About the question. Its A Look at MCV and TIBC it isnt iron deficiency or anything else except for choice A.

Mistyped the answer.

Edited by new_n_lost on 04/15/08 - 03:24 PM

___________________
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."

macintosh
Forum Elite

Topics: 38
Posts: 178

04/15/08 - 09:29 AM

new_n_lost wrote:
Its C Look at MCV and TIBC it isnt iron deficiency or anything else except for choice A.

I am sorry, was that C? I think megaloblastic anemia is characteristic of folate deficieny. This pateint has a MICRocytic anemia. I think he has anemia of chronic disease. But why should hodgkin cause anemia??

Tiff
Forum Guru

Topics: 54
Posts: 563

04/15/08 - 02:10 PM

This question required me to apply more thought. I'm trying to think of the link between anemia and Hodgkins. Then I decided to think differently. I'm going with Choice E - marrow aplasia. I think this is a red cell aplasia. My reasoning is this... The MCV is normal and the reticulocyte count is normal. If the reticulocyte count was elevated I'd probably be thinking more hemolysis. But this guy has anemia with a normal MCV. That's why aplasia is the only one that makes sense to me.

new_n_lost
Politically InCorrect
avatar

Topics: 653
Posts: 6,075

04/15/08 - 05:07 PM

macintosh wrote:

new_n_lost wrote:
Its C Look at MCV and TIBC it isnt iron deficiency or anything else except for choice A.

No mate the answer to me was A it was a mistyped as C.

___________________
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."

jean robert
Forum Guru
avatar

Topics: 162
Posts: 669

04/19/08 - 03:24 PM

" Hodgkin disease-associated anemia is most commonly the anemia of chronic disease. However, it may result from bone marrow involvement by tumor or from the presence of an autoantibody (positive findings on a warm Coombs test). " emedicine

Anemia of Chronic Disease and Lab findings. (Rapid Review)

Decreased MCV, serum iron (N=50-170 µg/dl),TIBC and iron saturation

Correct answer: A

___________________
Great works are performed not by strength, but by perseverance.

jean robert
Forum Guru
avatar

Topics: 162
Posts: 669

04/19/08 - 03:35 PM

I want to share this info with u,it s interesting:

Pathogenesis of Anemia of chronic disease:

1.-Decreased synthesis of heme

2.- In some cases, there s a decrease renal production of EPO.

3.- Liver synthesis and release of HEPCIDIN

HEPCIDIN

a) is an Antimicrobial peptide

b)is an acute phase reactant released by the liver in response to inflammation

c) Enters macrophages and prevents the release of iron to transferrin (abnormal utilization of iron )

d) Causes that ferritin synthesis and iron stores increase in bone marrow macrophages

___________________
Great works are performed not by strength, but by perseverance.

spinal shock
Forum Senior
avatar

Topics: 12
Posts: 99

04/20/08 - 03:25 PM

#10

its anemia of chronic disease and A is the correct answer
i asked a haematology prof in messissipi

___________________
we expect others wishes, we dont miss something that we dont expect to have

You don't have permission to post.