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NBME 20 Answers

nbme20/Block 2/Question#17 (49.5 difficulty score)
A 57-year old man has a hemoglobin ...
Chronic obstructive pulmonary disease🔍

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 +14  upvote downvote
submitted by hayayah(990),
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ihsT si eavetcir piateyolhcym aev,r hwchi is ued to ihgh tdietual or ugnl ee.siasd S2Oa is wo,l dna EOP si re.eicsand

oeArthn ywa to rhapaopc teh quinotse is ionkgol ta teh olbod r.amse tIs' tpyetr raonlm n(o sagketyrcaymeo, no aidrsenec enmubr fo ett,aplles on ,sodr tinhong l,bue c.t)e A odolb asrme morf a DOPC epaitnt wlli be mra.lno sutJ na rdnceseai emnurb fo RCsB eud ot eth naceisedr OPE nldiaeg ot rneeaiscd bg.H

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. +14  

 +7  upvote downvote
submitted by alexb(42),
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I dfoecuns dylismytlposeca desmyrno hiwt impryar yesfoimilsbro ebcseau I gutohth 23- of tohse sRCB deoklo leki drtoerap csel.l sJtu lkie nhew hety ohsw na geami ofr busulol ipomehdipg dna eert'sh omse idrwe eodcns pri uhthogr the edrsab/lmmreuadl leary ngimka me hktni it's ont BP neve hhtugo I 'ondt okwn htaw slee it oluwd eb. lmf

whoissaad  Made the same mistake +4  
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  upvote downvote
submitted by strugglebus(154),
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tP hsa mlicyapythoe reva rftlorevelemiioya(p reod)sird ued to oncihcr phxioay deicund yb OD.CP lydoieM mapaaselit is xatre elludaymr spoietmoihaes eud ot eofbr.lsoyisim rreyadieHt hhreacosomsmito odluw avhe bene vpnreo yb a upssrnai uble inat.s smsnierpyelpH lodwu ahve acedsu asdeceerd BsC,R nad imesllaycysdpo ysdenmro dlwou ahev nhswo erAu sodr ro sb.ltsa

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. +12