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NBME 21 Answers

nbme21/Block 2/Question#7 (28.6 difficulty score)
A 50-year-old man with rheumatoid arthritis ...
Anemia of chronic disease🔍

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 +4  upvote downvote
submitted by dr.xx(129),
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Anmgo teh tsmo rnlaeeptv tiaogheclmo leosaiarmtibn in itnaptse wiht gahmucioolrte sdrsoedir aer hte inamae fo ncohicr eiaedss ,D)(CA a dlmi neaami taht si eagllynre mctm,yitpaoas and niro iidecnfeyc aemani.

nI i-ioceycrednnfi ,mnaiea eht BCIT uwldo hrihge ahnt 054004– m/dcgL eabsceu otsres uldwo eb wo.l

insteaPt ihtw RA yincaaclsolo aehv ocntneurcr iorn edyeniccfi ieaman dan ACD. Wehn siht ,csocur the olhgniobme eelvl saluyul osdpr to loebw 95. dgL,/ dan teh MVC is less anth .80


sympathetikey  Got the right answer too, but man, that whole "1 month after starting therapy" almost threw me off. +  
fkstpashls  all I do is put the wrong answer when I'm between two. Fuck +  

 +1  upvote downvote
submitted by ragacha(14),
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AF 0218 pega 490. daeAsotisc wiht mimianofaltn A,(R LES, KCD).

This one is fairly logical if you remember that bacteria LOVE our iron. So much so, that our body came up with a way around it. When an infection is detected by the body, it makes like a doomsday prepper and batons down the hatches.

"All the iron into the bones, quick (^ferritin)! Hide it from the intruders! Get those iron delivery trucks (ferritin) off the road (blood)!

with decreased ferritin comes a decrease capacity for binding iron in the blood

cooldudeboy1  i like the way to remember acd but there is no bacterial etiology in Rheumatoid arthritis is there? +  
the_enigma28  The body recognises chronic inflammatory states as infections +  
fatboyslim  Ferritin is not the "iron delivery trucks", that's actually TRANSFERRIN (transfers iron to liver and bone marrow). Ferritin is the STORAGE form of iron in the liver and bone marrow. In anemia of chronic disease, there usually is an inflammatory process going (whether infectious, auto-immune [as in this case of Rheumatoid Arthritis], or cancer). During inflammation, the body releases IL-6, which releases hepcidin. Hepcidin downregulates ferroportin channels in the gut and on macrophages; therefore you absorb less iron from the GI and iron is trapped in macrophages (ferritin) and cannot be used for RBC production. All this causes INCREASED FERRITIN, decreased TIBC (if ferritin goes up, TIBC goes down and vice versa), and decreased serum iron levels and TIBC saturation (the bone marrow will suck up all the serum iron to make RBCs because it cannot make use of the iron stored as ferritin). +7