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NBME 20 Answers

nbme20/Block 2/Question#17 (54.1 difficulty score)
A 57-year old man has a hemoglobin ...
Chronic obstructive pulmonary diseaseπŸ”
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 +15 
submitted by hayayah(1056),
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shTi is cerveiat yylcmtaeipoh ,vrea ciwhh is ude ot hghi atutdeli ro guln dsiasee. SO2a is ,wol nda EPO is icnsdar.ee

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mbourne  You shouldn't call it reactive polycythemia "vera", as polycythemia vera is a seperate disease with entirely different etiology. This is Reactive Polycythemia, or as another poster said, appropriate absolute polycythemia secondary to chronic hypoxia. +15  
j44n  i jumped on myelodysplastic thinking it was PV due to the jak w mutation but you technically get elevated everything in that mutation so it would be more than just RBC's +  
beetbox  I also thought it was PV. How can we tell reactive polycythemia from actual PV, if PV does not show other kinds of blood cell counts raised but just an isolate of RBC rise? +  



 +8 
submitted by alexb(45),
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I unesodcf yysceatopsmlild dosenmry thiw ayprimr eloosyibimfrs eabsuec I gohtuht 3-2 fo heots RBCs kdeool keli torperad .lecls utsJ kile hwen yhte sowh an agmie for ouulsbl ghiiepodmp dan heste'r smeo rdwei esdnco ipr gthoruh the emaalduslbdmrer/ erayl angikm me nikht si't ton BP enve uhotgh I ondt' nkow wtha esle ti dlouw be. fml

whoissaad  Made the same mistake +6  
targetusmle  i thought exactly the same!! 2 cells looked like tear drop cells :/ +2  
ilovemypuppies2295  I thought there were tear drop cells too. Seemed like it should be a metaplasia then. Oh well +  
lynn  I did the same, but looking at FA19 pg 423 it says "ineffective hematopoiesis --> defects in cell maturation of nonlymphoid lineage." You can get bilobed neutrophils, or if it progressed to AML you'd see auer rods. Nothing about tear drop cells. Then on pg 406 tear drop cells would be seen in myelofibrosis, and possibly thalassemias +  
waterloo  I thought the same, but I think that would be myelofibrosis, not myelodysplastic. Hb is really high here too. Pretty tricky for them to put that there, easy knee jerk. +1  
jawnmeechell  Interestingly enough, agnogenic myeloid metaplasia is the old name for myelofibrosis, with "agnogenic" being synonymous with "idiopathic." (or did everyone already know this) +  



 -7 
submitted by strugglebus(163),
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neonem  Right, I think this would be just called "appropriate absolute polycythemia", whereas polycythemia vera is due to a malignant JAK2 mutation and would be termed a type of chronic myeloproliferative disorder. +13