NBME 23 Accessory spleen (NBME Answers)

Retired NBME 23 Answers

nbme23/Block 3/Question#17 (reveal difficulty score)
A 24-year-old woman comes to the physician ...
Accessory spleen 🔍 / 📺 / 🌳 / 📖
tags:

+20 upvote downvote
submitted by ∗alexxxx30(68)

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did anyone else have to reread this question several times? The jumping back and forth from "this happened before, 1 week after, 6 weeks after" then this happened today, then" this happened 6 weeks postop" gave me whiplash. Tell the story in order! haha

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confidenceinterval RIP anyone with a learning disability. I honestly think someone tried really hard to write something this confusing. +4

faus305 Quentin Tarantino wrote this one +4

homersimpson Some Westworld Season 1 Shit +2

+10 upvote downvote
submitted by ∗yogi(19)

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ITP - Platelet + Ab goes to spleen - Lysed - Low plt count.After splenectomy - usually plt count improve and Peripheral blood smear show - HJ bodies as a sign of asplenia ( nuclear remnants in RBC usually removed by spleen). If there was an accessory spleen (which was not functional when the main spleen was working) will take over the function gradually - HJ bodies will disappear and Plt starts to lyse - which has happened in this case scenario.

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spow But why are there no bite cells? Question stem states that there is normal morphology? That's why I didn't pick accessory spleen +2

makinallkindzofgainz Bite cells are seen when splenic macrophages take "bites" out of hemoglobin precipitates in G6PD deficiency, which doesn't have to do with our question. This patient had a splenectomy 3 months ago, 6 weeks later showed Howell-Jolly bodies (asplenia), and then today now has normal erythrocytes (spleen is working again somehow = accessory spleen) +5

snripper @spow Bite cells are associated with G6PD deficiency, not ITP. +1

srdgreen123 Main takeaway is the HJ bodies. They're seen pretty much whenever you have no spleen. So if they dissapear, that means another spleen-like structure has showed up +3

+7 upvote downvote
submitted by ∗sympathetikey(1600)

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That's a new one....

https://en.wikipedia.org/wiki/Accessory_spleen

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sympathetikey Makes total sense looking back. Just didn't know that was a thing :) +38

sugaplum Fun fact: Meredith from Grey's anatomy got her idea for Mini livers from a patient who presented with an accessory spleen.... and who said watching TV doesn't count as studying +28

123ojm have gotten at least 10+ NBME or Uworld questions correct because of grey's anatomy +3

rongloz LOL got this right because of Grey's anatomy too +

chediakhigashi ...today years old +1

lulumomovicky I literally picked accessory spleens because in remembered Meredith did her mini liver lol +

+3 upvote downvote
submitted by ∗moxomonkey(20)

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the lack of Howell jolly bodies in asplenic patients is suggestive of accessory spleen

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+1 upvote downvote
submitted by ∗drschmoctor(137)

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I'd never heard of an accessory spleen and spent like 4 minutes talking myself into this one as it would explain the findings much better than the other options.

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