NBME Step 2 CK Form 6 Measurement of blood lead concentration (NBME Answers)

Retired NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 4/Question#45 (reveal difficulty score)
A 72-year-old man comes to the physician with ...
Measurement of blood lead concentration 🔍 / 📺 / 🌳 / 📖
tags: toxicity inc

+2 upvote downvote
submitted by ∗step_prep7(71)

get full access to all content ⋅ pick a username

Patient with risk factor for lead poisoning (homemade whiskey) presents with abdominal pain, neurologic symptoms, and a microcytic anemia, which are the three classic symptoms of lead poisoning
Key idea: Potential buzzwords that should trigger thought of lead poisoning include battery factory, homemade whiskey, renovating old house, etc.
Note: While not a high-yield association, lead poisoning can lead to worsening of gout

https://step-prep.org/tutoring/

get full access to all content ⋅ pick a username

+2 upvote downvote
submitted by ∗shastri96(17)

get full access to all content ⋅ pick a username

LEAD POISONING IN ADULTS: GI Symptoms: abd pain, constipation (acute) Neuro: Cognitive deficit, Peripheral neuropathy (chronic) Hematological: Anemia

this patient has Signs of chronic lead poisoning: nonspecific symptoms (eg fatigue, irritability, insomnia), HTN, motor and sensory deficits, cognitive defect.

So we check for elevated venous Lead levels and give chelation therapy.

get full access to all content ⋅ pick a username

tinylilron I was explaining his symptoms with his alcohol-use disorder but everything you said makes sense +2

jlbae https://www.cdc.gov/mmwr/preview/mmwrhtml/00016616.htm +2

+1 upvote downvote
submitted by ∗sassy_vulpix(23)

get full access to all content ⋅ pick a username

What about acute intermittent porphyria 2/2 alcohol? It also has painful abdomen, polyneuropathy

get full access to all content ⋅ pick a username

jmorga75 Most of the time AIP questions mention a positive family history for it, and symptoms that worsen with fasting. +

satanicdo they have similar symptoms because lead can disrupt heme synthesis (similar pathophysiology), but AIP causes discrete attacks of pain rather than continuous symptoms. also, lead poisoning can lead to microcytic anemia and hypertension +1

charcot_bouchard Both shares neuropathy, abdominal pain and neuropsych symptoms. But AIP pains are intermittent and can be very severe. Anemia push towards lead poisoning. Absent of urine color change also push towards lead. And make ur booze in your garage/celler Heck Ya Lead poisoning +1

+0 upvote downvote
submitted by ∗tinylilron(58)

get full access to all content ⋅ pick a username

Does anyone have any ideas for this one???

get full access to all content ⋅ pick a username

lubdub I think the homemade whisky is supposed to tip us off that he's got some goofy exposure. +3

+0 upvote downvote
submitted by ∗medpsychosis(147)

get full access to all content ⋅ pick a username

Homemade whiskey and moonshine require brewing and boiling in metal pots. This can cause the release of high levels of lead into the solution and in turn to the individual once consumed. Given that the symptoms are pretty vague and could fit more than one answer choice, I believe the NBME is encouraging us to start making our own homemade whiskey and moonshine so we can learn these things hands on!!!! Who's in?

https://www.cdc.gov/mmwr/preview/mmwrhtml/00016616.htm

get full access to all content ⋅ pick a username

Must-See Comments from step2ck_form6

szsnikaa on Germinal cell tumor
qfever on Glycogen storage disease, type II (Pompe's ...
sugaplum on Observation in the emergency department
sugaplum on Right vertebral
sugaplum on Patent ductus arteriosus
sugaplum on Borderline personality disorder
jlbae on An excess of very long chain fatty acids
carolebaskin on Gallstone ileus
medicalmike on Daily exercise program
carolebaskin on Pulmonary contusion
medicalmike on Wean from the ventilator
sugaplum on Right optic nerve
medicalmike on Obstruction of cerebrospinal fluid flow
derpymd on Observation in the emergency department