Archer USMLE Step 3 Blog

Question of the Week # 435

18 Responses

1. 

   DR Alan, on February 11, 2013 at 2:16 am said:

   A

   Reply
2. 

   Ka, on February 11, 2013 at 2:32 am said:

   D

   Reply
   • 

     seb, on October 29, 2015 at 6:33 pm said:

     would be the next best step but the question is asking for the best or the most accurate test which is flow cytometry for cd55 and cd59 ab for pnh

     Reply
3. 

   Shru, on February 11, 2013 at 2:45 am said:

   B) Flow Cytometry

   Reply
4. 

   Roy, on February 11, 2013 at 3:25 am said:

   Pnh? hemociderin in urine? Because pas medical h of trombosis and now coming with pancitopenia?

   Reply
5. 

   Dr Euro, on February 11, 2013 at 4:03 am said:

   D

   Reply
6. 

   Alam, on February 11, 2013 at 5:19 am said:

   B

   Reply
7. 

   Pre-med, on February 11, 2013 at 2:39 pm said:

   D

   Reply
8. 

   Adnan, on February 11, 2013 at 7:59 pm said:

   B, i think she has PNH/aplastic anemia or PNH/refractory anemia-myelodysplastic syndrome. Flow cytometry is diagnostic.

   Reply
9. 

   Mohajer, on February 11, 2013 at 9:19 pm said:

   B

   Reply
10. 

    tulsikumar, on March 1, 2013 at 9:33 pm said:

    is’n PNH present w/nocturnal hemoglobinuria? and she is bleeding with high retic,???what is the ans???

    Reply
11. 

    yunes, on April 12, 2013 at 6:41 pm said:

    b

    Reply
12. 

    Excel, on April 16, 2013 at 12:29 am said:

    a

    Reply
    • 

      tulsikumar Majumdar, on April 16, 2013 at 11:41 pm said:

      is the answer pnh??

      Reply
13. 

    JB, on April 20, 2013 at 5:34 pm said:

    Looks like B after ruling out other options !

    Reply
14. 

    docn, on May 29, 2013 at 3:09 am said:

    USMLE Forum
    Step 1
    Step 2 CK
    Step 2 CS
    Matching & Residency
    Step 3
    Miscellaneous
     
    Archives
     

     
      <<      >>  
    * archur q 435
      #727481  
      passion790 – 03/28/13 23:38
     
      435) A 29 year old woman is seen in your office for fatigue and exertional shortness of breath of 2 week duration. Past medical history is significant for hospitalization for splenic vein thrombosis 1 year ago. She received heparin 1 year ago and therafter, coumadin for 6 months. She is off anticoagulation now. Physical examination is unremarkable. Laboratory Studies reveal

    WBC 2400/µl

    HGB: 6.8 gm%

    MCV 84 fl

    Platelets : 80k/µl

    Reticulocyte count 4.5%

    Haptoglobin : Undetectable

    Lactic Dehydrogenase (LDH) 800U/L

    Direct Coombs Test : Negative

    Which of the following is the best step in diagnosing this condition?

    A) Hemoglobin Electrophoresis

    B) Flow cytometry

    C) Osmotic Fragility Test

    D) Urine Hemosiderin

    E) Heparin Antibody Testing
     
    Report Abuse
    * Re:archur q 435
    #2862462
      blankoff – 03/29/13 01:41
     
      B) Flow cytometry

    Diagnosis is Paroxysmal nocturnal hemoglobinuria (Pancytopenia including hemolytic anemia + negative coombs + thrombotic event).

    best initial diagnostic test –> Detection of CD 55 and CD59 through flow cytometry

    Reply
15. 

    emerald, on November 19, 2013 at 6:08 pm said:

    Answer: B .The triad of hemolytic anemia, pancytopenia, and thrombosis makes paroxysmal nocturnal hemoglobinuria (PNH) a truly unique clinical syndrome.

    Reply
16. 

    song, on October 15, 2014 at 1:14 am said:

    b

    Reply

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