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NBME 23 Answers

nbme23/Block 2/Question#24 (34.5 difficulty score)
A 46-year-old woman has a 1-day history of ...
Leukocyte alkaline phosphatase activity greater than 250 U/LπŸ”,πŸ“Ί

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submitted by vshummy(162),
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shiT qsountie is rodw orf wdor ni itrsF idA 0912 paeg 424 eundr .CLM -- I ddit' aeizelr ti wsa rehet unitl I tgo it owrg.n

vshummy  "Very low leukocyte alkaline phosphatase (LAP) as a result of low activity in malignant neutrophils vs benign neutrophilia (leukemoid reaction) in which LAP is increased due to increased leukocyte count with neutrophilia in response to stressors (eg, infections, medications, severe hemorrhage)." +5  

submitted by nlkrueger(44),
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hyw 'st,in "0% astbsl no eht erlrhaipep "srmae r?ghit si siht teh tisihsnginduig teruuf orf atecu eeumkila?

lispectedwumbologist  Because you'll see some blast cells in a leukemoid reaction. It won't be 0%. +8  
paulkarr  Also, don't get confused with 0% Basophils. Basophils are seen in CML but not in Leukemoid reactions. I just went with LAP because they pointed it out in the lab values. Had that not been there, I would have chosen "0% basophils" +1  
usmile1  the "left shift" you see in leukomoid reaction actually is describing the increase in immature leukocytes on CBC. that is why the LAP is important to be able to distinguish them +  

submitted by paulkarr(55),
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Ccrohni gnlosMueoye meieaukL vs kumeeidoL cRantoie sha a fwe ttfegadinrfinie erfeatus:

  • iioplahsBa acn eb eesn in Mtvleyeoieroliprfa sdsaseie such sa LCM. ,weervHo yeth are ont sene in umLekodei sotaenRic.

  • okucytLee eklAnila apoeaPshsht )LP(A si otnfe elteaedv in uekiLmdeo naoRtsiec. But ti liwl eb dadeersec in CLM aeebucs mnlroAba lselc 'odnt akme hte orlmna eynmze.

  • hloDe doiBes rea rstiraehitccca of Lekuidmoe iteasRcon. toN esen ni MLC.

As uvmsmyh iptendo otu F1029-A gp 424 hsa lla itsh nfomintroai sa wlel as WrodUl epI.b..mlro tsuj ncta' eems to dfni eht ID.Q. ebyMa esonemo seel acn ta-gamte .in

thotcandy  LAP 100-249 do not fall into the answer choice but would still be considered high value and thus +LAP to indicate leukemoid. A LAP- would be in the normal values which is 20-100, not below 250 like the answer choice indicates. +  

submitted by imnotarobotbut(161),
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oahamPt assy ehetr era 3 ihgnts htat ttnieidaferef emlikeuod romf + L:MC eouytkLce aklilnae assehahptop yonl( ni iel)ekmod+ u saphBlosi lony( in +)CM L 9t)(22; ortcsataloinn loyn( in M)LC

nor16  yeah but pathoma doesnt help here... +1  
thotcandy  Yeah but LAP is normally 20-100 so a 100-250 U/L is still + which would indicate Leukemoid reaction, no? That's why I didn't pick it, Because I figured 250 u/l was just some random number and it didn't make sense. a -LAP would be in the normal range, 20-100 which would THEN indicate CML. +  

submitted by aakb(10),

can someone explain to me why 0% basophils is incorrect?