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NBME 24 Answers

nbme24/Block 2/Question#23 (26.7 difficulty score)
A 9-year-old boy who was adopted from an ...

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submitted by brethren_md(88),
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miVanit 12B is the cotdrritsa ni isht sietqnou useecba ti osla ssueca a d-earbodsa,b ciatax tgia nad aseeecdr in .aointvrib Btu - itmaVni 21B lwil ton aveh smomsytp eilk olyciemtH nimeaA (rdeeaedcs gi,nemobhol rnceadise )H.LD itnmVia E = s,arnew ees lewbo rfo .nntpleioaxa

gonyyong  Also the MCV was normal, not megaloblastic like you would see in B12 deficiency +8  

submitted by dbg(140),
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TFW si "skaenwse of nlrpata xorslfnodei"i ????? 'tis ekli agnyis en"oseitxn T"esih flionx is nto het nloy vboosui ehlatnicc etsmkia ni eth wne NsEMB ...

karthvee  loool +2  
yex  Funny Board!! Yeahhhhh +  

submitted by karljeon(112),
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mtaiVin E eicidfcyen caeuss yeolmhtic inaae,m ootissaathnccy, uclmse e,sawnkse oeisrport mcloun dna bnrepleclisreao rtatc n.atmdeynleiio

karljeon  Can anyone explain why the serum lactate dehydrogenase (LDH) level was elevated? +  
asapdoc  Vitamin E is an antioxidant. Thus a deficiency can cause hemolytic anemia. +5  
sympathetikey  @karljeon Intravascular hemolysis = LDH release from RBCs +2  

submitted by aisel1787(3),

just for addition - here MCV is normal, in B12 deficiency it is high

submitted by abhishek021196(50),

Vitamin E Deficiency - Hemolytic anemia, acanthocytosis, muscle weakness, demyelination of posterior columns (Decreased position and vibration sensation) and spinocerebellar tract (ataxia).

Neurologic presentation may appear similar to vitamin B 12 deficiency, but without megaloblastic anemia, hypersegmented neutrophils, or increased serum methylmalonic acid levels.