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NBME 20 Answers

nbme20/Block 3/Question#10 (25.4 difficulty score)
A 59-year-old man develops fatigue and ...

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submitted by divya(58),
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FA 1290 gP 145

croePthist treah sevval nda atcrio toseisns may esuac tohcmiley nimaae yceadonrs to imcaalcnhe setdcoirtun fo BsR.C

submitted by lilyo(69),
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cPtorhetsi aesvlv rea eon of teh ucesas fo arrxlvcastuea hsilseymo os uesstpc hist ni a ietpnta taht sah somytpsm fo aeiman ushc as iuetf,ag plalor, jda.niuec rrFtheu pognrupsti eenidecv in htis epnaitt si teh rndasceie irtdeicn uib.nrbiil slo,A look fro teevldea ,LHD readcsede ahtlb.poniog

nephroguy  All of this is correct except its intravascular hemolysis, not extravascular. Also look for hemosiderinuria, hemoglobinuria and schistocytes on blood smear +2  
dermgirl  Is not intravascular hemolysis, it is extrinsic hemolysis, specifically macroangiopathic hemolytic anemia. FA 2020 page 423. +  
vishnu_c_singh  This is actually BOTH intravascular hemolysis & extrinsic hemolysis. Extrinsic = hemolysis that isn't caused by an internal defect of the RBCs, like an enzyme/membrane defect (in other words, it's hemolysis due to an external factor like a mechanical valve). Intravascular = hemolysis that occurs within the blood vessels (RBCs get damaged as they pass through the valve). This is in contrast to extravascular hemolysis which describes hemolysis that occurs outside of the blood vessels (e.g. inside the spleen) +4  

submitted by lebron james(16),
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htis eudd dah a omlcicitopna toaicr evval aeernpcmetl cihhw eh nwo pstneesr twhi a dsdoenrccee tisidaloc mrmuru ta teh eftl srelnat oebrrd coiA(rt hTe CBsR eesm ot get eserdha sa yhte assp utrh eth ytlufa pingeon fo the eldeacrp evalv auinscg alcisnaratvru iysoheslm

submitted by jotajota94(13),
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hWne gtdjenaocu blirnibui (C)B is esls n,da 3%0 fo tatlo tb-&igr-ini;lu-b- einrscdea het tnoipordcu fo ucndanuejtgo rbniulbii ro dscaeeder a.eupkt Hlismoesy si eth eibposls neraws

BC is 0%5%0-3 uhiirb-xpramieelyiinmb .x(E aipsietHt or lCoAocl Bh)l si eomr nhat 0%5 -tg-;& Ornobcttuis (anrit ro rc)eaaitthexp