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NBME 22 Answers

nbme22/Block 1/Question#15

A 35-year-old woman has weakness and fever. When ...

Acute myelocytic leukemia

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Alkylating agents (merchlorethamine) (the other drugs listed are microtubule inhibitors) increase the risk of AML.

keycompany  Additionally, AML is the only answer choice that has multiple blast forms (myeloblasts, promyelocytes, etc.). ALL is characterized by a single blast form (lymphoblasts). +10  
seagull  CML has blasts too but they tend to favor mature forms. +3  
kash1f  You see numerous blast forms == AML, which is characterized by >20% blasts +2  
keycompany  The answer choices are all of lymphoid origin except for AML and Hodgkin Disease. We know Hodgkin Disease is a lymphoma (not leukemia) and would present with lymphadenoapthy. So the answer must be AML #testtakingstrategies +6  
impostersyndromel1000  @atstillisafraud thanks for mentioning the merchlorethamine increasing risk for AML, i was trying to make a connection with the drugs but couldnt. Had to lean on the test taking skills just like key company +  
sweetmed  Procarbazine is alkylating as well. +  

 +2  upvote downvote
submitted by d_holles(38),

Goljan stresses the Boards giving the leukemia questions away based on the age given in the question stems.

ALL = 0-14

AML = 15-39; 40-59

CLL = 60+

CML = 40-59


impostersyndromel1000  thanks for the reminder, often overlooked are the simple demographic hints. helps you make an educated guess +  
hyperfukus  also a key thing to remember in general is a person who undergoes chemo is a big demographic hint to later developing AML regardless of the clues :) and yes the AGE!!! +  

 +2  upvote downvote
submitted by sweetmed(38),

Procarbazine side effect is leukemia. FA 2018 page 428