need help with your account or subscription? click here to email us (or see the contact page)
join telegramNEW! discord
jump to exam page:
search for anything ⋅ score predictor (โ€œpredict me!โ€)

Retired NBME 16 Answers

nbme16/Block 3/Question#50 (reveal difficulty score)
A 10-year-old girl has fatigue and appears ...
Deficiency of erythrocyte spectrin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags:

 Login (or register) to see more


 +3  upvote downvote
submitted by โˆ—bingcentipede(359)
get full access to all contentpick a username

This is hereditary spherocytosis. The image stinks, but the cells are not super pale in the middle and they're round. Her dad also had a splenectomy (HS is autosomal dominant), which is the definitive treatment for HS.

Pt is also normocytic (90.2 um^3), so a lot of the other answer choices can be eliminated based off this.

In the end, screw this picture because it's not clear and you can't zoom in.

get full access to all contentpick a username
motherhen  Sad picture... I definitely thought this was B-thalessemia since the image looked like different size and shaped RBCs (anisopoikilocytosis). But if I squint my eyes real hard and turn sideways I guess I can also see those spheres +4
furqanka  beta thal, iron def and inadequate epo would have low reticulocyte count. impaired oxidative enzyme aka g6pd deficiency affects mostly males and would have bite cells +1
an1  Even if you can't see the picture, we can rule out B-thal, Fe def because these are microcytic. Oxidation defects are X-linked, so very rare to be seen in girls. adn that leaves EPO production. EPO production can be Relative (dehydration) or absolute (polycythemia where all the cells lines are increased and secondary; where there is hypoxia, high altitudes; no hx to support this or tutors like reninomb). we could deduce from the info given that its HS. but if all else failed, we can clearly see that we have some small and small 'larger' abcs. the small ones don' have colour variation. that makes HS the most likely +1



Must-See Comments from nbme16

bingcentipede on Cerebral edema
zincy7 on Gastrin
cassdawg on Kidney
medninja on Lysosomes
cassdawg on Sildenafil
cassdawg on Feces-contaminated soil
cassdawg on Presence of an internal ribosome entry site
cassdawg on Peutz-Jeghers
hungrybox on Induction of cytochrome P450 enzymes that ...
andro on Antagonizes VLDL-cholesterol secretion
bingcentipede on Decreased function of Na+โ€“K+ ATPase
bingcentipede on Glyceraldehyde-3-phosphate dehydrogenase
cassdawg on 46,XXY
bingcentipede on Grade 4/6, holosystolic murmur heard best ...

search for anything NEW!