NBME 22 Acute myelocytic leukemia (NBME Answers)

Retired NBME 22 Answers

nbme22/Block 1/Question#15 (reveal difficulty score)
A 35-year-old woman has weakness and fever. ...
Acute myelocytic leukemia 🔍 / 📺 / 🌳 / 📖
tags: hemeonc repeat

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submitted by ∗d_holles(218)

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Goljan stresses the Boards giving the leukemia questions away based on the age given in the question stems.

ALL = 0-14

AML = 15-39; 40-59

CLL = 60+

CML = 40-59

https://forums.studentdoctor.net/threads/goljan-on-leukemias.303605/

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impostersyndromel1000 thanks for the reminder, often overlooked are the simple demographic hints. helps you make an educated guess +2

hyperfukus also a key thing to remember in general is a person who undergoes chemo is a big demographic hint to later developing AML regardless of the clues :) and yes the AGE!!! +4

+12 upvote downvote
submitted by ∗atstillisafraud(217)

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Alkylating agents (merchlorethamine) (the other drugs listed are microtubule inhibitors) increase the risk of AML.

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keycompany Additionally, AML is the only answer choice that has multiple blast forms (myeloblasts, promyelocytes, etc.). ALL is characterized by a single blast form (lymphoblasts). +31

seagull CML has blasts too but they tend to favor mature forms. +5

kash1f You see numerous blast forms == AML, which is characterized by >20% blasts +11

keycompany The answer choices are all of lymphoid origin except for AML and Hodgkin Disease. We know Hodgkin Disease is a lymphoma (not leukemia) and would present with lymphadenoapthy. So the answer must be AML #testtakingstrategies +13

impostersyndromel1000 @atstillisafraud thanks for mentioning the merchlorethamine increasing risk for AML, i was trying to make a connection with the drugs but couldnt. Had to lean on the test taking skills just like key company +2

sweetmed Procarbazine is alkylating as well. +1

pg32 @keycompany how did you know the phrase "multiple blast forms" meant literally different types of blasts and not just many blast cells were seen? +4

castlblack this link says CLL has 'large lymphocytic variety' under the picture of the peripheral smear. I am not arguing against you, just researching here https://emedicine.medscape.com/article/199313-workup +1

jurrutia @keycompany, how did you know it had to be of myeloid origin? +1

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submitted by ∗sweetmed(157)

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Procarbazine side effect is leukemia. FA 2018 page 428

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bdaines8 Perfect, that narrows it down to three answers +12

escherichia95 My man here murdering by words. ROFL. +

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submitted by ∗namesthegame22(14)

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AML is an aggressive malignancy of myeloid cells and commoniy presents in adults with pancytopenia and circulating blasts on peripheral smear.
Gingival hypertrophy is not an uncommon finding and represents infiltration of the gingiva by malignant cells.
Depending upon the types of mutations present, patients are divided into good, intermediate, or poor risk subcategories. Those with poor risk disease invariably go on to stem ceil transplant after induction and consolidation chemotherapy.

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