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NBME 23 Answers

nbme23/Block 3/Question#17 (40.5 difficulty score)
A 24-year-old woman comes to the physician ...
Accessory spleen🔍
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h'tsTa a ewn n.o.e..

/sniiolAh.stwkt.:ypace/gewriiik//snreodpc_psee

sympathetikey  Makes total sense looking back. Just didn't know that was a thing :) +14  
sugaplum  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 +18  
123ojm  have gotten at least 10+ NBME or Uworld questions correct because of grey's anatomy +2  
rongloz  LOL got this right because of Grey's anatomy too +  
chediakhigashi  ...today years old +  



 +6  upvote downvote
submitted by alexxxx30(26),

did anyone else have to reread this question several times? The jumping back and forth from "this happened before, 1 week after, 6 weeks after" then this happened today, then" this happened 6 weeks postop" gave me whiplash. Tell the story in order! haha

confidenceinterval  RIP anyone with a learning disability. I honestly think someone tried really hard to write something this confusing. +1  



 +5  upvote downvote
submitted by yogi(10),
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ITP - atllPeet + Ab egso ot eelsnp - sdLye - owL ltp ntceuo.rftA lmsnpoeceyt - uyllsau plt tcoun ievprmo and Pieelraphr ldoob mares swoh - JH sidboe sa a gisn fo leasnipa ( erulnca nmsetran ni BRC suluyal eemdrov by ).lnpsee I f erhet aws an eycorassc elspen w(hcih was ont talifuncon ehnw teh inam pelens wsa okrnig)w lliw tkea vero hte toufinnc aydrlglua - HJ dbioes wlil aapidesrp dna Ptl sratts ot ysle - wcihh hsa dahpenep ni tsih seca i.recason

spow  But why are there no bite cells? Question stem states that there is normal morphology? That's why I didn't pick accessory spleen +2  
makinallkindzofgainz  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) +3  
snripper  @spow Bite cells are associated with G6PD deficiency, not ITP. +1  
srdgreen123  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 +1  



the lack of Howell jolly bodies in asplenic patients is suggestive of accessory spleen




I'd never heard of an accessory spleen and spent like 4 minutes talking myself into this one as it would explain the findings much better than the other options.