USMLE Forum Archives - USMLE Step 2 CK - anemia
anemia
ysemak - 01-14-10 10:03
A 47-year-old woman presents to your office complaining of tongue soreness, fatigue, and dyspnea with exertion. She denies unusual bleeding, weight loss, fevers, and night sweats. Her past medical history includes hypothyroidism, for which she takes levothyroxine, and she does not drink alcohol or smoke. Physical exam reveals a tired-appearing woman with lemon-yellow colored skin, temperature 37 C, pulse 110, blood pressure 120/74, and respirations 12. The exam is otherwise unremarkable. A CBC demonstrates a WBC count 4,000/mm3, hemoglobin 9 g/dl, platelet count 140,000/mm3, and a MCV of 105 fl. Her B12 level is 100 pg/ml (normal > 300pg/ml) and folate 40 ng/ml.
ysemak - 01-14-10 10:03
A 47-year-old woman presents to your office complaining of tongue soreness, fatigue, and dyspnea with exertion. She denies unusual bleeding, weight loss, fevers, and night sweats. Her past medical history includes hypothyroidism, for which she takes levothyroxine, and she does not drink alcohol or smoke. Physical exam reveals a tired-appearing woman with lemon-yellow colored skin, temperature 37 C, pulse 110, blood pressure 120/74, and respirations 12. The exam is otherwise unremarkable. A CBC demonstrates a WBC count 4,000/mm3, hemoglobin 9 g/dl, platelet count 140,000/mm3, and a MCV of 105 fl. Her B12 level is 100 pg/ml (normal > 300pg/ml) and folate 40 ng/ml.
The correct answer and explanation will be available after you answer.
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#1
Re: anemia conym5 - 01-14-10 10:56 My answer is: c.
with tongue soreness, fatigue, and dyspnea with exertion, one can suspect B12 deficiency, but tired-appearing woman with lemon-yellow colored skin, hypothyroidism gives the clue for autoimmune history..
#2
Re: anemia
ysemak - 01-14-10 12:00 Sorry, I didn't include q-n into the thread.
Q.
Any of the following historical elements will aid in the diagnose EXCEPT:
#4
Re: anemia conym5 - 01-15-10 04:29 upppps, i even felt the question incomplete, still went with hypothyroidism
if the question is all , except , then i ll go with d. History of new vegetarian diet started last month.coz it takes years to develope B12 deficiency
#10
Re: anemia mtniharika - 01-17-10 13:07 My answer is: e.
achlorhydria-induced malabsorption
Deficient intake
Deficient intrinsic factor (pernicious anemia or gastrectomy)
Biological competition for B12 by diverticulosis, fistula, intestinal anastomosis, and infection by the marine parasite Diphyllobothrium latum
Selective B12 malabsorption (congenital and drug-induced)
Chronic pancreatitis
Ileal resection and bypass
Nitrous oxyde anaesthesis
Folate deficiency:
alcoholism
Deficient intake.
Increased needs: pregnancy, infant, rapid cellular proliferation, and cirrhosis
Malabsorption (congenital and drug-induced)
Intestinal and jujenal resection
Combined Deficiency (Tropical sprue): Vitamin B12 & Folate.
vit b12 stored in liver is usually sufficient for 3 months.
#38
Re: anemia ammulufy - 03-12-10 20:42 My answer is: e.
The patient's Vit.B12 levels r low which probably might b due to deficiency of IF frm d stomach following gastrointestinal surgery.
#39
Re: anemia ammulufy - 03-12-10 20:48 hey harika.....whr r u frm.....seem to b perfct in ur subject.....i liked ur response....anywys I am Amritha....frm OMC,Hyd.,....currently doin my house surgency......plannin to give step 2 frst n den step 1.....wht abt u???
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