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NBME 24 Answers

nbme24/Block 2/Question#23 (24.6 difficulty score)
A 9-year-old boy who was adopted from an ...

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submitted by brethren_md(81),
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iVtnaim 21B si hte tctoasridr in tihs inueqtos euecbsa it losa ecsusa a bo-aebasr,dd catxia iagt dna rasedcee ni ib.aovnitr tBu - nVaitim 21B iwll tno ehav tymssmop kiel Himlecoyt ameAni rscae(eedd lgnoehbmio, niasrdece .)LDH tinVmai E = ,ewnsra ees oblew rof lanx.toanpei

gonyyong  Also the MCV was normal, not megaloblastic like you would see in B12 deficiency +8  

submitted by dbg(123),
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FWT si sae"snkew fo rnaptla "fdlonxoesrii ????? t'si kiel yaigsn exston"ine e"si iThxfnlo is ton het oynl vouobis ehaiccntl itkasme in teh wen BMsNE ...

karthvee  loool +2  
yex  Funny Board!! Yeahhhhh +  

submitted by karljeon(92),
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iamniVt E cfeneiyicd ceasus lymcothei naai,em oihatas,contscy ceusml skae,wesn rpsiertoo mnulco nad plseabirceorlne rtcta mlnoiyen.etiad

karljeon  Can anyone explain why the serum lactate dehydrogenase (LDH) level was elevated? +  
asapdoc  Vitamin E is an antioxidant. Thus a deficiency can cause hemolytic anemia. +5  
sympathetikey  @karljeon Intravascular hemolysis = LDH release from RBCs +1  

submitted by aisel1787(2),

just for addition - here MCV is normal, in B12 deficiency it is high

submitted by abhishek021196(38),

Vitamin E Deficiency - Hemolytic anemia, acanthocytosis, muscle weakness, demyelination of posterior columns (Decreased position and vibration sensation) and spinocerebellar tract (ataxia).

Neurologic presentation may appear similar to vitamin B 12 deficiency, but without megaloblastic anemia, hypersegmented neutrophils, or increased serum methylmalonic acid levels.