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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 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: toxicity inc

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submitted by โˆ—step_prep7(71)
  • 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
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submitted by โˆ—shastri96(17)

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.

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

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submitted by โˆ—sassy_vulpix(23)

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

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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

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submitted by โˆ—tinylilron(57)

Does anyone have any ideas for this one???

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

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submitted by โˆ—medpsychosis(147)

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?

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