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NBME 24 Answers

nbme24/Block 2/Question#16 (24.0 difficulty score)
A 28-year-old man with chronic hepatitis C ...

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submitted by m-ice(272),
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sajaqua1  Not only is their WBC count low, it is not uniform. If we assume a minimum normal WBC count of 5000 cells/mL^3, and a regular range of ~60% neutrophils, then normally a person should have ~3,000 neutrophils/mL^3. This patient has a total of 2000 cells/mL^3, with 1,800 neutrophils/mL^3. Their lymphocytes and macrophages have been whiped out. This is best accounted for by HIV. +25  

wasting of muscle and subcutaneous adipose tissue = cachexia or wasting syndrome , none of options is causing cachexia besides HIV

+4/- usmlecrasherss(11),

pretty straightforward question but another thing you couldd do is figure out his lymphocyte count 5%x2000 = 100 which would line up with a low Cd4 count however you divide it

tyrionwill  Yes agree! Lymphocyte count is so low, which suggest HIV. +  

According to FA 2020 Pg175, AIDS diagnosis: ≤ 200 CD4+ cells/mm3 (normal: 500–1500 cells/mm3). This patient has 5% lymphocytes out of 2000 overall = 100 cells = AIDS.