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NBME 17 Answers

nbme17/Block 4/Question#23 (6.3 difficulty score)
A previously healthy 72-year-old man is ...
Gastrointestinal blood loss🔍

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submitted by covid_19(3),

Aplastic anemia: anemia, leukopenia, thrombocytopenia

CML, i.e. leukemias: anemia, ↓ mature WBC, ↓ plt, peripheral blood smear shows mature & maturing granulocytes (FA 2020, p. 432)

β-thalassemia major: microcytic, hypochromic anemia with target cells and anisopoikilocytosis, skeletal deformities, etc. (FA 2020, p. 418)

Cobalamin deficiency: d/t malabsorption, pancreatic insufficiency, gastrectomy, or insufficient intake, neurological Sx

Personally, I got this wrong, because to me, the RBCs in that smear looked both larger and more irregularly shaped, so in hindsight, I really should've honed in more on the HPI, i.e. the patient really has anemia and no other relevant PMx.

flapjacks  I believe Goljan mentions that the #1 cause of anemia in older adults is GI bleeds +2  
flapjacks  (colon cancer) +  
mark0polo  Also, B-thalassemia major would present in childhood, not in a 75 year old man +  

 +0  upvote downvote
submitted by nsinghey(0),

Believe this is straight up iron deficiency anemia due to the hypochromic RBCs and normal blood values. Plus hes old