Q92) 67 year old african american man presents to your office for regular check up. He has no significant past medical history. He underwent a screening colonoscopy 5 years ago that was normal . He underwent a PSA testing 3 months ago and it was 2.5. The patient denies any complaints. He denies any fatigue or recent weight changes. He denies alcohol use or smoking. He does not use any medications at home. Physical examination is normal. Routine laboratory investigations reveal a WBC count of 4200/µl, Hemoglobin of 9.6gm% , Mean Corpuscular Volume of 106, Reticulocyte count of 1% and Platelet count of 152,000/µl. Peripheral smear reveal macrocytosis and hyposegmented neutrophils. B12 level 540 pmol/L, TSH 2.0 ( N = 0.3 – 4.2) miU/L and Folic acid level is with in normal limits. Lactic Dehydrogenase is 170 *( normal). Haptoglobin is 220( normal). Most likely etiology of this patient’s anemia?
A) Iron deficiency
B) Subclinical Vitamin B12 Deficiency
C) Subclinical Hypothyroidism
D) Hemolytic Anemia
E) Myelodysplatic Syndrome
Q93) The next best step in obtaining the diagnosis :
A) Serum Ferritin
B) Methylmalonic Acid Level
C) Free T4 and T3 level
D) G6PD level
E) Bone marrow biopsy
Archer USMLE Step 3 Blog 
B
D
E.Myelodysplastic Syndrome
–>Elderly
–>Special Neutrophil with 2 lobes called Pelger -Huet Cell
—>RBC->MCV
E.Bone Marrow Biopsy
ee
E/E
E,E
Treatment is transfusion support, azacitidine decreases transfusion dependence
can we please have an explanation and correct answer, myelodysplastic syndrome seems the right answer, but need adequate explanation
Xplanation plz
c,c
c,c
E E