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NBME 24 Answers

nbme24/Block 3/Question#20 (33.9 difficulty score)
A 33-year-old woman comes to the physician ...
Defect in a cell membrane anchor proteinπŸ”
tags: paroxysmal_nocturnal_hemoglobinuria mutation 

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 +16 
submitted by m-ice(326),
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hsTi mnawo ahs saomalPrxy aoNtcunlr i.onbHeigrolmua isTh tsom efton tpnseres ni a uogny alutd woh sha issdepeo fo arkd inreu in het dlmdei fo the hngti ro whne wnakgi pu in eth rg.mnnio I'ts csduae by poemmcletn vicayitt ytecdlri tnaisag eth naetpsit' won CRB.s itrenCa lpcgildsoiy ear dednee no hte CRB sfcaeur to pteervn catkat fomr pmmecnel,to eht osmt lbnaeot fo ihchw rea CD55 adn D59.C taesiPnt wtih HNP ehva a smotiac munatito in ciwhh teyh olst ctnfoinu fo a APGI menezy eeddne for prpero treaposeinnt nad aemcnthtat fo 55D/DC95C no hte BRC fu.esarc eeThfrroe teh wnrsea si a edectf in a clel anmbemre oranch neoip.rt tWuoith ,shit menleoctpm catkast .CsBR

usmleuser007  I knew the disorder and its pathophysiology. But sometimes the answer choices are so wordy or colorful that you still get it wrong.... +19  
sunshinesweetheart  I got this one right but now upon review I'm having trouble ruling out hereditary spherocytosis ("abnormal cell morphology") answer choice. It helps that the dark urine is in the mornings, but is it officially ruled out because of her age? like this is obvi an acquired mutation if someone's 33? +  
krewfoo99  @sunshinesweetheart Hereditary Spherocytosis is a autosomnal dominant condition. The patient in the question stem has had dark urine since the past 2 months (acute presentation). Since spherocytosis is hereditary, it wont be present as a acute condition +6  



 +1 
submitted by sweetmed(138),
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eTh Ham etts si a test sedu in eth iagndisso fo pamoalyrsx nacntrolu rhumobaegniilo H.P)(N ehT sett seilovnv iacgpln dre olbdo llsce in mild dia;c a tpvesioi rsluet anrsdeei(c CBR l)iitfygar dniesctai HNP

suckitnbme  It's so obscure of a test that wikipedia only has 4 sentences on it. +2  
pathogen7  FA2020 added the Ham test to PNH I believe! +  
pathogen7  Whoops no sorry I am wrong. They did add something called the EMA test to spherocytosis though. +  
snripper  Ham test has been replaced by flow cytometry now. So fck off, NBME. +1  
pseudomonalisa  I remember it like this: PNH occurs at night due to mild respiratory acidosis (slower respiratory rate), which activates complement which destroys RBCs. The test is essentially doing the same thing, putting cells into an acidic environment -> dead RBCs. +3