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NBME 24 Answers

nbme24/Block 3/Question#20 (29.7 difficulty score)
A 33-year-old woman comes to the physician ...
Defect in a cell membrane anchor protein🔍
tags: paroxysmal_nocturnal_hemoglobinuria mutation 

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 +14  upvote downvote
submitted by m-ice(272),
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hsTi moanw hsa Poralmxsya ucrnaNotl eoliionurb.gHma Tihs sotm eofnt estnspre ni a nogyu udlat how has opeessdi fo rdak rinue in eth iedldm fo hte htnig ro nwhe gwanki pu ni the gminnro. 'Its aeducs by nleeomtcpm tciyvati ylrietdc gianats het ttenpis'a nwo sC.RB anitrCe ycdipiogsll ear deende on eth RBC csfuear ot tneperv aktcta mfor ptm,mleecon eht smto ltaebon fo ihchw ear 5D5C adn 95CD. iPtatsne hiwt PHN vaeh a stamcoi ttiauomn in chwih ythe tsol nfutncio fo a IPAG nmzyee eddene rfo peorrp stnnoipaeetr dna tntatamceh fo 5CCD59D/5 on the BCR c.reuasf forhTeeer hte nerwsa is a fetecd ni a ecll nmaberme rcanho eotpri.n ohitWtu ith,s tpemneolcm caksatt .RsCB

usmleuser007  I knew the disorder and its pathophysiology. But sometimes the answer choices are so wordy or colorful that you still get it wrong.... +13  
sunshinesweetheart  I got this one right but now upon review I'm having trouble ruling out hereditary spherocytosis ("abnormal cell morphology") answer choice. It helps that the dark urine is in the mornings, but is it officially ruled out because of her age? like this is obvi an acquired mutation if someone's 33? +  
krewfoo99  @sunshinesweetheart Hereditary Spherocytosis is a autosomnal dominant condition. The patient in the question stem has had dark urine since the past 2 months (acute presentation). Since spherocytosis is hereditary, it wont be present as a acute condition +4  



 +1  upvote downvote
submitted by sweetmed(123),
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hTe amH etst si a etst seud in teh nidgasiso fo saaxylopmr nrauoclnt milhgeoibornua NH)P.( ehT tset nslviveo agilncp rde bdool lsecl in mldi id;ac a potvieis lesrtu eesdaincr( BCR ylagr)fiti idetniasc HPN

suckitnbme  It's so obscure of a test that wikipedia only has 4 sentences on it. +1  
pathogen7  FA2020 added the Ham test to PNH I believe! +  
pathogen7  Whoops no sorry I am wrong. They did add something called the EMA test to spherocytosis though. +  
snripper  Ham test has been replaced by flow cytometry now. So fck off, NBME. +  
pseudomonalisa  I remember it like this: PNH occurs at night due to mild respiratory acidosis (slower respiratory rate), which activates complement which destroys RBCs. The test is essentially doing the same thing, putting cells into an acidic environment -> dead RBCs. +1