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NBME 16 Answers

nbme16/Block 3/Question#50 (8.5 difficulty score)
A 10-year-old girl has fatigue and appears ...
Deficiency of erythrocyte spectrinπŸ”
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 +2 
submitted by bingcentipede(219),

This is hereditary spherocytosis. The image stinks, but the cells are not super pale in the middle and they're round. Her dad also had a splenectomy (HS is autosomal dominant), which is the definitive treatment for HS.

Pt is also normocytic (90.2 um^3), so a lot of the other answer choices can be eliminated based off this.

In the end, screw this picture because it's not clear and you can't zoom in.

motherhen  Sad picture... I definitely thought this was B-thalessemia since the image looked like different size and shaped RBCs (anisopoikilocytosis). But if I squint my eyes real hard and turn sideways I guess I can also see those spheres +1  
furqanka  beta thal, iron def and inadequate epo would have low reticulocyte count. impaired oxidative enzyme aka g6pd deficiency affects mostly males and would have bite cells +