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Retired NBME Step 2 CK Form 8 Answers

step2ck_form8/Block 3/Question#6 (reveal difficulty score)
A 67-year-old woman comes to the physician ...
Chronic inflammation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: hemeonc

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submitted by โˆ—step_prep(148)
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  • Elderly woman with rheumatoid arthritis presents with pallor and is found to have a microcytic anemia with a decreased TIBC (indicative of increased ferritin stores), most consistent with anemia of chronic disease
  • Iron deficiency (microcytic anemia): Iron labs show low iron, increased TIBC and decreased ferritin (often seen in young women due to menses and in older patient is colon cancer until proven otherwise)
  • Lead poisoning (microcytic anemia): Patient with exposure who has abdominal pain, neurologic symptoms, etc.
  • Key idea: While rheumatoid arthritis can be associated with anemia of chronic disease, osteoarthritis is NOT associated with anemia of chronic disease

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lilmonkey  In other words, Iron deficiency looks the same on labs but TIBC is increased (asking for more iron). In this case, TIBC is ok (don't need more iron). +1



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