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Retired NBME 27 Answers

nbme27/Block 1/Question#41 (reveal difficulty score)
A 16-year-old girl with cystic fibrosis is ...
Vitamin E ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—shak360(20)
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Some vitamin facts that I have trouble remembering:

Vitamin E deficiency - hemolytic anemia, acanthocytosis, muscle weakness, demyelination of posterior columns (DCML) (decreased position and vibration sensation), and spinocerebellar tract (ataxia). The neurologic presentation appears similar to vitamin B12 deficiency, but without the megaloblastic anemia, hypersegmented neutrophils, or increased serum methylmalonic acid levels.

Vitamin A excess - acutely causes nausea, vomiting, vertigo, and blurred vision, but chronically causes alopecia, dry skin (scaliness), hepatic toxicity and enlargement, arthralgia, and idiopathic intracranial hypertension

all-trans retinoic acid (Vitamin A derivative) and arsenic are used to treat acute promyelocytic leukemia (M3) (Auer rods, myeloperoxidase positive cytoplasmic inclusions, t(15;17))

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shak360  PML-RARA is an oncogene present in acute promyelocytic leukemia (APL) and is associated with a t(15;17) translocation. Histologically, Auer rods are often seen within promyelocytes. The release of Auer rods (composed of myeloperoxidase) into circulation can precipitate DIC so we should look for elevated D-dimer, decreased fibrinogen, increased bleeding time, and signs of microangiopathic hemolytic anemia (schistocytes). +



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