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NBME 18 Answers

nbme18/Block 3/Question#25

63 yo man, 2 weeks of fullness in left upper quadrant of abdomen

Myelofibrosis

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Dry tap + massive splenomegaly + abnormal RBCs is classic for myelofibrosis





This patient has a dry tap, which is seen in myelofibrosis and aplastic anemia. The abnormal RBC are most likely dacrocytes (teardrop cells).

AML would have auer rods and many circulating myeloblasts, but nor abnormal RBC.

CML, defined by the t[9;22] Philadelphia chromosome, will have many mature and maturing granulocytes, with a low LAP because this is not a leukemoid reaction.

Dysmyelopoietic syndrome is the same as a myselodysplastic syndrome, which are a group of cancers with immature RBC in the bone marrow that do not become mature. https://en.wikipedia.org/wiki/Myelodysplastic_syndrome

Essential thrombocythemia (which is not essential polycythemia) is just a rare cancer with high platelets, which presents with abnormal blood clotting, leading to thrombosis, strokes, and PE.

Polycythemia vera has very large RBC mass and low EPO due to negative feedback. It is due to a JAK2 mutation and also has high WBC and platelets. Our patient is anemic.

https://www.youtube.com/usmlelive





This patient has a dry tap, which is seen in myelofibrosis and aplastic anemia. The abnormal RBC are most likely dacrocytes (teardrop cells).

AML would have auer rods and many circulating myeloblasts, but nor abnormal RBC. CML, defined by the t[9;22] Philadelphia chromosome, will have many mature and maturing granulocytes, with a low LAP because this is not a leukemoid reaction. Dysmyelopoietic syndrome is the same as a myselodysplastic syndrome, which are a group of cancers with immature RBC in the bone marrow that do not become mature. https://en.wikipedia.org/wiki/Myelodysplastic_syndrome Essential thrombocythemia (which is not essential polycythemia) is just a rare cancer with high platelets, which presents with abnormal blood clotting, leading to thrombosis, strokes, and PE. Polycythemia vera (pg 466) has very large RBC mass and low EPO due to negative feedback. It is due to a JAK2 mutation and also has high WBC and platelets. Our patient is anemic.

https://www.youtube.com/usmlelive





his patient has a dry tap, which is seen in myelofibrosis and aplastic anemia. The abnormal RBC are most likely dacrocytes (teardrop cells).

AML would have auer rods and many circulating myeloblasts, but nor abnormal RBC.

CML, defined by the t[9;22] Philadelphia chromosome, will have many mature and maturing granulocytes, with a low LAP because this is not a leukemoid reaction.

Dysmyelopoietic syndrome is the same as a myselodysplastic syndrome, which are a group of cancers with immature RBC in the bone marrow that do not become mature. https://en.wikipedia.org/wiki/Myelodysplastic_syndrome

Essential thrombocythemia (which is not essential polycythemia) is just a rare cancer with high platelets, which presents with abnormal blood clotting, leading to thrombosis, strokes, and PE.

Polycythemia vera has very large RBC mass and low EPO due to negative feedback. It is due to a JAK2 mutation and also has high WBC and platelets. Our patient is anemic.

https://www.youtube.com/usmlelive