NBME 21 Answers : Block 3 : #20 = A 68-year-old woman has had a fever and shortness ...

NBME Answers & Explanations

NBME 21 Answers

nbme21/Block 3/Question#20

A 68-year-old woman has had a fever and shortness ...

Reactive granulocytosis

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submitted by hungrybox(241),

some wrong answers:

acute lymphoid leukemia (ALL): Look at these MONSTER lymphocytes. High N/C ratio.
acute myeloid leukemia (AML): Watch out for the faggot cells (a faggot is a bundle of sticks). The sticks are crystals made of MPO.*
chronic lymphocytic leukemia (CLL): Smudge cells are characteristic. Can transform into diffuse large B-cell lymphoma (Richter transformation)

*makes sense b/c myeloblasts are precursors to granulocytes, which use MPO to fight off infections

temmy Hungrybox aka life saver +

hello Thank you!!! +

+3 upvote downvote
submitted by seagull(433),

The patient has a fever/infection. The picutre shows normal (1 immature) granulocytes (neutrophils). The immature might be part of the left-shift occuring in this patient. Therefore, this is simply a reactive immune process.

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submitted by dragon3(4),

What's the difference between reactive granulocytosis vs lymphocytosis?

whossayin Yes I’m at a loss for this one too. Still can’t figure out how we’re expected to differentiate those based on this slide shown. The only logical explanation that I can think of is that reactive lymphocytes may be seen in LYMPHOMAS as opposed to granulocytes which are seen in LEUKEMIAS Such a shitty way to trick us, hah! +

henoch280 reactive lymphocytes are seen in EBV infection. you would see lymphocytes in the slide not neutrophils FA2018 pg 165 +3

whossayin That makes sense.. but was the question talking about EBV infections or hematological malignancies? Just a vague question I wasn’t really sure what exactly was it trying to teach us, I guess the reactive lymphocytosis just threw me off! Anyways, thanks for the clarification buddy! +

ratadecalle They way I thought about it was: Granulocytes: multi lobed nucleus Lymphocytes: single lobe +2

hello @whossayin - it's not reactive lymphocytosis because there are no buzzword type symtoms of EBV in the Q stem. Also, reactive lymphocytes look way different. +

+0 upvote downvote
submitted by minhphuongpnt07(1),

There's a band cell in the middle=> left shift reactive granulocytosis

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submitted by step1soon(9),

We can rule out A B and C because its cancer and pt will present w/ weight loss. Here the pt likely has pneumonia w/ elevated leukocyte count indicating infection. On PBS, cells look like neutrophils (seen in acute inflammatory states) which are granulocytes therefore it is reactive granulocytosis.