NBME 23 Answers ↦
(40.5 difficulty score)
A 24-year-old woman comes to the physician ...
Makes total sense looking back. Just didn't know that was a thing :)
Fun fact: Meredith from Grey's anatomy got her idea for Mini livers from a patient who presented with an accessory spleen.... and who said watching TV doesn't count as studying
have gotten at least 10+ NBME or Uworld questions correct because of grey's anatomy
LOL got this right because of Grey's anatomy too
RIP anyone with a learning disability. I honestly think someone tried really hard to write something this confusing.
But why are there no bite cells? Question stem states that there is normal morphology? That's why I didn't pick accessory spleen
Bite cells are seen when splenic macrophages take "bites" out of hemoglobin precipitates in G6PD deficiency, which doesn't have to do with our question.
This patient had a splenectomy 3 months ago, 6 weeks later showed Howell-Jolly bodies (asplenia), and then today now has normal erythrocytes (spleen is working again somehow = accessory spleen)
@spow Bite cells are associated with G6PD deficiency, not ITP.
Main takeaway is the HJ bodies. They're seen pretty much whenever you have no spleen. So if they dissapear, that means another spleen-like structure has showed up