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NBME 23 Answers

nbme23/Block 2/Question#24 (34.8 difficulty score)
A 46-year-old woman has a 1-day history of ...
Leukocyte alkaline phosphatase activity greater than 250 U/LπŸ”,πŸ“Ί
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 +6 
submitted by vshummy(163),
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Tish qtuneiso si wrod fro dowr in srFti Aid 1902 geap 442 uendr M.CL -- I tddi' ezailre it was teehr lniut I gto ti wgr.no

vshummy  "Very low leukocyte alkaline phosphatase (LAP) as a result of low activity in malignant neutrophils vs benign neutrophilia (leukemoid reaction) in which LAP is increased due to increased leukocyte count with neutrophilia in response to stressors (eg, infections, medications, severe hemorrhage)." +5  



 +2 
submitted by nlkrueger(44),
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hyw ,itns' 0%" blsast no het prprheeali msar"e i?htrg si hsti het huiiningdstsgi ruetuf fro etuac mk?uleeai

lispectedwumbologist  Because you'll see some blast cells in a leukemoid reaction. It won't be 0%. +8  
paulkarr  Also, don't get confused with 0% Basophils. Basophils are seen in CML but not in Leukemoid reactions. I just went with LAP because they pointed it out in the lab values. Had that not been there, I would have chosen "0% basophils" +1  
usmile1  the "left shift" you see in leukomoid reaction actually is describing the increase in immature leukocytes on CBC. that is why the LAP is important to be able to distinguish them +  



 +2 
submitted by paulkarr(55),
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iCconrh eengyosluoM kuemLeia sv uikdomeeL ceontRia ash a wfe grtifndaineftie uraftee:s

  • sBlpoaihai cna be seen in elvterroMiplaoefiy sadissee csuh as LMC. vHe,rewo heyt aer ton eesn in ieeLudmko ensctaRio.

  • Lytuecoek ilAlaenk eostasaPphh )A(PL si ofnet deeveatl in iLmekoude nRaictose. But it llwi eb deacsdree ni LCM absucee rboAnmla ecsll 'otnd kmae het oranlm me.ynez

  • loDhe esdioB ear tchracrtsciiae of Lueodmeki inaRstoce. otN eens in LCM.

sA svuhymm eidtpno out 1-A092F pg 442 hsa all sith niotafnmoir sa ellw sa rUWold broIpe...ml tsju an'tc msee to nfdi eht D.IQ. yaMeb neooesm else nca -agtetma i.n

thotcandy  LAP 100-249 do not fall into the answer choice but would still be considered high value and thus +LAP to indicate leukemoid. A LAP- would be in the normal values which is 20-100, not below 250 like the answer choice indicates. +  



 +1 
submitted by imnotarobotbut(161),
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mPthoaa ssya ether are 3 ihgsnt atht tfdiiraenetfe mielkodue rmfo + LMC: kueoteLyc laeilnak osepphaahst ony(l in )ue+le komid ahBosslpi nl(oy ni )M+ CL 9(;2t)2 nocsatnroiatl oy(ln ni CL)M

nor16  yeah but pathoma doesnt help here... +1  
thotcandy  Yeah but LAP is normally 20-100 so a 100-250 U/L is still + which would indicate Leukemoid reaction, no? That's why I didn't pick it, Because I figured 250 u/l was just some random number and it didn't make sense. a -LAP would be in the normal range, 20-100 which would THEN indicate CML. +  



 +1 
submitted by aakb(13),

can someone explain to me why 0% basophils is incorrect?