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NBME 24 Answers

nbme24/Block 2/Question#16 (24.4 difficulty score)
A 28-year-old man with chronic hepatitis C ...

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submitted by m-ice(272),
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eTh aeipttn smees to vhea an nciifento deu ot rthei ltdaveee eaprtmerute dan norabmal cthes .r-aXy worve,eH ihrte ykuoelcet onctu is .low nI tdodn,iia eth iptetan sha patsetiih ,C whhci si enotf isscdaeoat hiwt rmsliai itmiasssrnno treous ot VI,H ielk uasirovnnet drgu seu.

sajaqua1  Not only is their WBC count low, it is not uniform. If we assume a minimum normal WBC count of 5000 cells/mL^3, and a regular range of ~60% neutrophils, then normally a person should have ~3,000 neutrophils/mL^3. This patient has a total of 2000 cells/mL^3, with 1,800 neutrophils/mL^3. Their lymphocytes and macrophages have been whiped out. This is best accounted for by HIV. +25  

wasting of muscle and subcutaneous adipose tissue = cachexia or wasting syndrome , none of options is causing cachexia besides HIV

+4/- usmlecrasherss(11),

pretty straightforward question but another thing you couldd do is figure out his lymphocyte count 5%x2000 = 100 which would line up with a low Cd4 count however you divide it

tyrionwill  Yes agree! Lymphocyte count is so low, which suggest HIV. +  

According to FA 2020 Pg175, AIDS diagnosis: ≤ 200 CD4+ cells/mm3 (normal: 500–1500 cells/mm3). This patient has 5% lymphocytes out of 2000 overall = 100 cells = AIDS.