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Retired NBME 22 Answers

nbme22/Block 1/Question#28 (reveal difficulty score)
A 48-year-old man comes to the physician ...
Transferrin saturation and serum ferritin measurements ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: hemeonc

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 +9  upvote downvote
submitted by โˆ—lamhtu(139)
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Hemochromatosis associated with HLA-A3, but the appropriate screening test is serum transferrin saturation and ferritin levels

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homersimpson  So when do you perform HLA testing? Is it a confirmatory test? +2
weirdmed51  HLA typing is genetic testing- so canโ€™t be screening. Could be confirmatory +1



 +7  upvote downvote
submitted by โˆ—drmohandes(193)
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Iron accumulation causes free radical damage in organs:

  • liver โ†’ dysfunction / ascites / cirrhosis
  • pancreas โ†’ glucose intolerance (diabetes)
  • heart โ†’ cardiac enlargement (LVF can leads to prominent pulmonary vasculature)

Also notice patient + older brother are >40, which is when total iron body accumulates enough to cause symptoms.

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 +5  upvote downvote
submitted by โˆ—keycompany(351)
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While this question stem is vague, the most likely diagnosis is Hereditary Hemochromatosis.

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 +2  upvote downvote
submitted by โˆ—happysingh(57)
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Hemochromatosis (Auto Recessive HFE Gene on Ch.6) Labs :

โ†‘โ†‘ Serum Iron & Ferritin & Transferrin saturation

โ†“TIBC

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