Question of the Week # 435

Posted on February 11, 2013 by Archer USMLE Reviews

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

Filed under: Uncategorized, USMLE Test Prep | Tagged: archer general internal medicine, Archer hematology, Hematology, usmle hematalogy, USMLE step 3 Hematology |

18 Responses

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

A

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

B) Flow Cytometry

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

D

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

B

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

D

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

B

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

b

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

Looks like B after ruling out other options !

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

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

b

Reply