‘10 oat boy wth sony 21 aos at is annua checkup wah his editkin, He parts explin that over tho past week, be hasbeen ceasing “wiraun anaehorge On exam, ymph nodee appear elrged around the lf doo nock, cthorwise thre a nomal dings. The padtrcon ordre somo routine blood wore ho ects fhe complete Sood count ac ts mit Hemoglobin. 51g. a Mev 7k ma MoH 195pg MCHC 28g. Potosts 270 WL Diternist ymphootes 94% Monecyes 2% Peripheral smear demonstrated some evidence of inmate calls ae he se Was referedtohemstopathoogy On foweeytomety, te coll were found to be CALLA (010) nogatno. Wn of ho fowng csoesoss most esocatod wi nose leial and etloicl ings? 3 A Hany cal oven WS SbebeeeuuNaaveeesercnar eal}wHeWreoes Musser eves casas Nouropras lymphocytes 94% Monecyes 24 Parptera smoardamonstated some evidence of immature calls ae he aso Was referred hamatopathoiogy On floweytomety, the ol wero found to bo CALLA (CO 0) negate. Which of he folowing ceases is most essocated wi these canical anc ettescl tangs? £8, Precursor Tacte lymphoblastic every mphoma 2. Chsslc Hodkin' phoma 0. Pocusor 8 acutoymphoblascadamiaympnoma > E Diss igo 8 cll phomaNouropras lymphocytes 94% Monecyes 24 Parptera smoardamonstated some evidence of immature calls ae he aso Was referred hamatopathoiogy On floweytomety, the ol wero found to bo CALLA (COO) negatve. Which ofthe flowing cseoces most essocated wih these ‘ical and elo tangs? 18, Precursor T acute ymphobastieuemiaymphoma {© Chesc Hodkin's ymehome 0. Pocusor 8 acu phobias auomiaympnoma bifus large 8 cll phoma WS SbebeeeuuNaaveeesercnar. " ” = » = Explanation: Correct answer Procurcr Tse nphcblsticlukamiaslpnghomas ae ‘most conmerly CO 1 negative They ae ko tpl TaT pov. These ‘ast are usualy CD2, CDS, and COS postive ALL assetted with an rlrge thymus. There so an aszocation wih crn whe have Dawn’ Symrome developing AL ner in chhood ‘Option A: Hay cot eukert storey CD10 posi. tf considered 3B «all ncage leuko, More corimory these leukemias are pole or CD03, {CD ne, ana CD 25 an nagatve er CD, cD 1 and CD23 ‘Option c: casic Hoag ymphamais mos equentyconscoved 8 call tineage leukomis ands sometimes found to be CD 10 postive, Open: Procirscr ace hmphobleticloukemiaynphoma evry ommerty CD 10 posite. They are also typical TAT postive. ‘Option: Dis large 8 el nchoma Is sometimes CD 10 postive. much mote requenty tan Teo leukemias Leaming ebjectiv: CALLA (CD10) spies negatve in ‘oukomasrymphomas dering trom the Teal ineag, whi ti typiaty posite in those dering fom Bea ineoge. Related Videos: © tons eet at Psy Lesser As imphoote os) Whi le Co © Prsesy © tesennincraaen First Aid References: Fst Ad forthe USMLE Step 12018, 20h 04 Fst Ad forthe USMLE Stop 12018, 28 a: 420, Fst Afr the USMLE Stop 1201727 od 10‘st. year-ol man prsont 10 an cupationt cri wih chon Tague and bumps oo his rock ight anand groin. Upon questioning horovals he ecuerty sts Japan on eusess andi rather promioUs on Ns business tps. He denies use of barr protection. On examinaten more genealzodiynphadenepsy Routine lnb wok eves abnormal mphoces on peripheral smear. The srum calcium s : Roel) 122m ict tote ser sce we ee terse? © A Human mmunodeicencyveus © B Hepat wus © Hepatitis vrs © D.Human Tymphotopie vn 2 © Human Tiymphouepl wins 1 WS SbebeeeuuNaaveeesercnarWS SbebeeeuuNaaveeesercnar ‘4 s.year-ol man prsont oan cupatint crc wih chon fatigue an bumps ‘hs neck right alla and grin. Upon questioning. he reveals he reqventy vs Japan on sess andi rather promiuoUs on Ms business tps. He denies use ‘ot barter rooction. On exansnaton tore generatzod iymphedencoety. Routine ab work reveals abnormal hrmphocycson peripheral moa Tho serum Cale s 122 mg/d, Whicref te folowng wruses i assocated wth Ps patents © A Hume immunodecioney veus 8. Hepat Cus C Hapatis 8 vrus ‘Human Tympntopie wus 2 Saiaga Human Fhmphotopevius 1See L Bees BUSAN ve Sevesssarecaseevsesu Explanation: ‘corect answer E: This patent wth cron fatgue mph node volvement 3 igh alum ve and ast of unsafe seul pracice meskes dt “col turin HTLV hs ben kc os condion by select Infecing cls. Human Fo immphotopic vrus TU 3 retro that cates RNA that elactvely infects Tall, Approxinatly 2-54 of ese patonts wa go no dovolep aut T cteukemia ough an unknown ‘process, HTLV! a bod bome econ that common ansmted ‘evualy or vough needles and is endemic n Japan, Southeast Ai, nthe ‘Option A: Athough HV can caso von fatgue andentaged mph nes, ‘tiene peal secocted vith Mah clean evele nor abremal ymphoer ficings ‘OptonsB and ¢:Both hepatitis B and Care boos bome pathogens however ‘yplal symptoms ince hepatic disease wih eaocated blogg chemtry ‘Option: Human Tcl ymphowepe wus 2(HTL.2} nat kes to any sun malignncy,nonever HTIN2 causes an increased ae of chest and ‘ladder bacterial nfeclons oer tie, HTL-2 fa bood-borneifecton hate commanty uancitod sual oteugh needles and is endaricin western Related Videos: Leukemi Tpes of eukem ck Hy et Lekems HCL ond Ad © cattetonistyrenema ATE} Wh Blood Cet Patleay First Aid References: Fst Ad forthe USMLE Stop 12019, 28h oa 226,22 Fst Ad forthe USMLE Stop 12018, 260 oh 1 Fst Afr the USMLE Stop 12017 270) 405WS See Be eeeu Seay eves esses acacenwoas ‘Corset E: This nt With rec aii ph niece iven | igh alum ve and ahstoryof unsafe sewal racice mesh has adult Teel leukemia HTLV has been lke o ti condton by selectively ‘etecing cls. Human cot ympoople ves ATU sa eos thet Cores RNA tat selectively infects Tals, Aperoxinataly 2-54 of tse patents wl goon te doveep adult T cll eukemia ough an unknown proces, HTL1i a blo bom hecton tat common tansmted ‘sewunly or trounh asd ands endemic in Japan, Southeast Asia, che CCasbbean, ‘Option A: Athough HV can ene cron at gue andeniaged mph noes ‘snot ypialyassocated vt ih calaum leelsnorabnamal ympnocye findings. pone @ and C-Both hepatitis B an Care blood bome pathogens however ‘yplcaleympomslnckiie Hepat dseae wth sociated blood cherry ‘Option: Human T ” = {A styoarld Asan woman rosens thet pinay cave prow wh abdominal rn, On examination shes fund te have rebound tenderness inthe omer ih ‘quadrant othr abdomen, Further workup suggest evan cancer, which © onfmed ter nthe woek obo Staga with cotimed star metastascs Inthe lungs ane brain. Which of the folowing routes describes the mot lymphatic route fort matkmancy have metastasted othe br? | Sentinal node left lumbar unk sea chy ‘ronehemodastina unk right lmphatic dct sucavan vin systemic creation D Serine! node-let lumbar tunk- cisterna cht-thorace dite subi van -sstomi euaion {Senin node ight mbar tuk cera cyl rorchamecastina run -rigkthmphatie dct Moh eucavian ven systamic creation 2D. Senin! nodo rit umber tuk cites ch - thoracic dct. ‘pt etleian vhs pean heath £ Sanne node ght lar turk sera chy-thorecte det leftsubalavan vein sytem ckultion{A styoarld Asan woman rosens thet pinay cave prow wh abdominal rn, On examination shes fund te have rebound tenderness inthe omer ih ‘quadrant othr abdomen, Further workup suggest evan cancer, which © onfmed ter nthe woek obo Staga with cotimed star metastascs Inthe lungs ane brain. Which of the folowing routes describes the mot lymphatic route fort matkmancy have metastasted othe br? | Sentinal node left lumbar unk sea chy ‘ronehemodastina nunk-right hyphae dct sucavan vein systemic crcloen| £8. Senne node left umbar turk stema c-thorale dt let subciavan vein systemic creuaton| {Senin node ight mbar tuk cera cyl ronchemedastia nk -righthmphatie duct ng sucavan won sjstomiecrculaton| 1. Seti! node riot mbar rk itera chy - thoracic duct. ‘pt etleian vhs pean heath £ Santne node ght lumbar tuk sera c-torecte ct let subclavan von sytem creuaton Result: Lesva WS SbebeeeuuNaaveeesercnar1 > 2° a i Explanation: Related Videos: Cin ner Ti sort et om a rn ye hil a aaa Me | Sccnoue ccuamom ome uavieemcwaccem, | | Ona a jporenst aa besiepaectnta wees Scat onsen se agitate ee cr AAO Se See cermcantenatmn cen Soper Poe Option B: The sontinol nege for 9 right sided ovarian cancor will moet IEcoly_ First Aid References: enactment irate! are 20 7 ae mean esce Eeewecre cue, | aamcmmneemen foals promt rei rome Pepe een arene ‘option D: The tral dt dove not fed no the ight subclavian oi, rather B sctr ttt WS See beaeUuNaaveeesersnarecaceeseWS See beaeUuNaaveeesersnarecaceese tothesyremicceciation, San metistaeefaytee, ae ovarian cance wl ‘play invade local siuctes st nthe pertaneal space, Homeve, _sévancod disease can peony sprad through he rte decribed Ms Imporantto meme tat te right mphate duct only rans the right ‘movedecavty, the igh an, andthe ight se of he neck and Mead ‘Option A: Agathe sentinel node for arght-sted ovarian cancer wil mst thay inva aoeal Semel nado rather han ho ose, So nvoNemat of the let ambos ty ‘Option B: The seine node fra ht sed ovarian cancer il mot Ikly Invade aloe enti nose rator than the fia Hanes the ant mbar ‘uu ext bo the mest aly avenue er esseminaton ro the est othe ype sytem, rathor han fe lumbar (Option: Ti an atractive option for hore ha ono undertone _symmtie yrphate ranage nthe body ana a revert teetod cance ‘The a renehomedisinal duct doesnot aren om te ower abaomen ok ‘option D: The morale duct dave not fed no tho ight subtavian oi rather ‘feds in thee sudan ven, Loaring objective: Understand that cancor wl ply Invade amp nodes ‘hat dan ne are nvehement sent nodes then spread the decton C]ttympn teeta ater mph nodes and the est the body. Roa at timatlyiymph drainage te asymmetic, with Bort phate duct ery ‘raring the ight horace cay, the ight arm, anche ight sie of the neck Lumohate Drange — lymph Branage of Abdominopele Organs First Aid References: Fst A forthe USMLE Step 1 (2019, 2h od: 97 Fst Ad forthe USMLE Step 1 (2018, 28 od 97 Fst Afr the USMLE Step 1 2017, 27h 93WS SbebeeeuuNaaveeesercnar ‘Tr yearott woman presets othe emergency toom wth tho compli of ovr, Inala, and right sees Sho recemlyobsorved an elagement fhe allan, Iymph nodes, wnicn che examines on a wocky bas. She haba remote Metory of breast cancer in he 6 thet was oad with adaton end cmenerapy. She also ropersaictory of extensive ravelto Ac and 930 peck ear history of smoking ‘On piyscal exam, several airy lymphinodes are palpable wth alge non tender Plpable mass i er ight ana Measung 0x8 cm, Fineneedieasptation emanates what the pathelogt oaciss 22 centeblasticoeimmasnabistic ‘ca presence, uspeus or non Hodgkn’s phoma NHL- ” = ‘1.46 you-la woman present to her prmaty cto pyscan wi complaints of Increasing let upper quran confor. Shobos a known hisiow of ype TGaucher ‘asease.Onprpical examination, her epeen papa 8 cm blew he costa ‘marin Routine laboratory werk evi sovore pancytopenia. Ror consutatin wh tho patent onthe risks of her contion the patent decides to under 9 slenectomy. Whe of tho fetlonng is mre oly o occurs a consequence of Stlenectomy ths paien? 8, Preumnococca septicemia c Tivombocropenia 10. staprococea septicemia E Lovkopenio" : x = ‘46 you-l8 woman present to her prmaty cate pyscan wi complaints of Increasing let upper quran confor, Shas a known histow of ype t Cache gee. Onpysesl amaton, her epson papapie& em blow the costal magn Routine laboratory work reveals sovorepancyopenta. Aer ‘consuation wth the patent on the ks of he condition. the paint decides © Undergo splenectomy. Whlc fhe follwing Fema sy to oct a 3 consequence ofspenectamy i this patent? 8. Preunococea septicemia om © Thrombocytopenia » 10. staprococea septicemia was E Lovkopenio *7 ” = » = Explanation: Ccorect answer 8: This pation has massive splenomegaly secondary to type (Gaucher dase ich vais rom ie accunulaton of lucsycermide erie tom he breakcown of senescrd lado end ewocyio membranes Splenectomy s a veatmert open for massive symptom splenomegaly, However splenectomy hes several consequences + increase in trombbecyts and eskoeytes due to these cls no longer boing stored in a spleen + erase in Howel-Joly boss and Heine bodes, which ae pial removedinthe spleen by splenic macrophages. + Most mparanty hare a decreas ine ait of tho cy og ot Infectone by onepeuato bata (09. Sbeplocoecue preumeniae Ipreumocoecs) and Hoemephiusravenzoe “The spleen plays amajr role nthe opsonization of bacteria, a primary means by whch bacten ate marked fo destucton by the immune system. Patents srotypealy vaccinated post splenectomy with tho pneumocozcal conjugate ‘ncone, meningococeal vaccine, and Hb vaccines fo protect again he most ‘common pathogens. ‘Option A: Anemia has not been demonstiated in post-splenectomy path fact becouse of me ack a moval of doectvo rd cls Tom culation, First Aid References: Fst Ad forthe USMLE Step 12019, 20h od: 88, 98,128,136 Fst Ad forthe USMLE Stop 12018, 25) 88, 98,128,156 Fst Ad forthe USMLE Stop 12017, 27h ed 84, 96,124,152WS eee beeeuuNeayesesesssas acl Lesva + Mostimorony ols a decresein He ay ofthe body tft of Infections by enezpsuste bacteria (eg, Sraptococcus pneumoniae Ipnoumacoces) and Hoomapnusnuen2a0, ‘Te spleen plays amajr role the opsonization of actea, a primary means Ly nich bacteria re mutked for destcton by thoimmune syst ater _aretypcalyvaccnated post-splenecomy wih the pneurococcalconugate ‘occne meningacacal vaccine, and Sb vaccine to protect agit he most ‘common patiogens ‘Option A: Anema nae not heen domonsised in post plenectony pater fact because of the ack of removal of deective rd els rom culation, ‘hare ee netincessen rcusing ethos ‘Option: Dust leck of sequestration within the splen, there facta and observed trombocyosis aha than vombecyopan ‘Option: Though splenectomy can cause increased suscep te saps, this more tly rom encapsulted ergrisms. Slapyococcus speci are ‘gram postive coc! hat are nt eneapssed. ‘Option E: Sia. eres leuko-yoss postspenectomy. not ekopeia \Loaring objective: Splenectomy has soveral ical consequances eeu Im ncreasod erculating eels of eytocyes and platelets, nerensed ‘ncidance of Howat ty and Hom bodes, 2nd. most importantly, creased ‘rok of tons by encapsulated bacei, Pst splenectomy patos sould recetve the preumececcal conjugate vacene,meningococealvacone, and Hib \vocanesto protect agar the most commen pathogens.‘3 year tls rough by hex pants oe ofico fr Heady darhoa anda seizure. Tho prons so sho started having fever. sbdominalpan and dorhoa about 3 days agp, bur the Bloody earhea states 12 hows ao. The cezure was the last symptom 19 appee3 hous ago and consisted of epctite movomant at ‘arms and legs wt sso coreciousness Hor 4 year-ol brother had sir case tithoody aha 2 weeks go, Her wal sgn ned Hood presse 12085 rum Hg ne espsty fete 25min ex heats 20! et {temperate 38.2 (0267) On physical examination, se leks pale and eee, the eardopumonary avcutitons noma the abe pa on pation, andthe sin assessment revats te presence of scented papa petechiog, “The riya show hori, The Coons ets negative. The compote ood count rons tea ollous Hemogebin Talal Homsteert 25% ‘oukosye count 17000m [Noutophis 70% ‘ean m Basophis Iymphootes 27% s 700K? " : x = Monocytes Pltit court Her coagulation tests are a allows: Paroltromboplostn time ctvated) 30 seconds Protromin ne ‘2 econde eal}WS SbebeeeuuNaaveeesercnar Eosinopis 8 Basophis mpnoores 27% Monocyte 55 Pht count 7000!mm* Her coagulation toss area allows: Paraltromboplestn tme activated) 30 seconds Roteuloeys count 1% “Trombintine «Deacon devon or contol \Wnatis te mos ety agnosis? 18. Henoeh Schon purpura Salmons nection © D.5ystome vases DE Hemolnicaremic smdomeWS SbebeeeuuNaaveeesercnar Her Eosinopis 8 Basophis mpnoores 27% Monocyte 55 Pht count 7000!mm* coagulation tsi are as flows: Paraltromboplestn tme activated) 30 seconds Roteuloeys count 1% “Trombintine «Deacon devon or contol \Wnatis te mos ety agnosis? ‘8. Henoeh Schone purpura Salmon infection 1. systemic vascus Heroitcaremi sdiomeExplanation: Related Videos: Ccomect answor E: Hemobic uremic synaromo MUS) usualy deine by the following isd: sate Kknoy nr, miroongiopthic hemob anemia and ‘tromboeytepeni (see mage below) Sig oxnproceng Eecheneha cell (STEG). 5 a secondary causa ot HUS that account for ove 90 potart of petiac cass, The mos common sertype of STECn the United Satsis (O1S7H7 The prodrome in cen with STEC HUS pal has abdominal ‘al, vorting, and dara usualy body, HUS presents wi the lowing _lossical findings 5-10 deys ater the onset of ciathon: First Aid References: 1 cate kcnoy jury Fst A forthe USMLE Step 12019, 2th od 19 + Sevety may ange fom hematuria an protean to severe Keney fours and otgconuta Hypertension frequent Athough af ho Pons require dais curing the act praca he Progtos for Fst Ad forthe USMLE Step 12017270 405 recovery of Kney tneion generally ovorabe, + Micreanlopathic hema anemia + Hemogioin is usualy below & ft. Tho Coombs tats nogae, en the petpheral blood sen characterized by the large number of enstoeyter an helmet te © [enabetene stone sn onsen Frat Aid forthe USMLE Stop 1 (2018, 20 od 5 ” = »Patlt courts are generally axound 4,000im. Theres no eatcaon ‘between the anemia ane thrombocytopenia wth the seventy ofthe rent 20% rater of Date the ‘bone marr the presence of primary granules cae Aver rods aed aro ‘sual seen cider adit nthe Gt decade of Mo AML scwcd Fo ‘ytomoeptological subtypes, named MO to M7 according the Fen -morian Bits FAB) asian, The high types of AML are docrbed Int ble |. Ace promyelocyteleukeria MB] nas the folewes essngushing Factors: + Myetoperoskase postive + Ocews auto a7 mutaion rat vansoests me uno ca recapeo (RAR) on cvomesome 17 to chvomosome 5. The RAR Inparentterfres ts the maturation f premyelootes. The accumulation of Aer rds an fod he development of assomnatoainvavascul coagulepaty, which 2 common cause of oat + ory responsive to trestment with alta tink acl /ATRA} 2 ‘vramin A desvative wc binds to the paved receptor end Related Videos: Luci Aeute Ml Leukemia (AML) — White Blood Cel Patholoay First Aid References: Fst Ad forthe USMLE Step 12019, 20h e424 Pst ad forthe USMLE Step 1 (2018, 280 ea: 420, Fst Ad forthe USMLE Step 1204727 10promotes the maturation of bls 2. Reato monocyte luk (U5 + canbe ban myetaporeuidase paste oF negative + Thermonoblss nla the guns, causing gum hyperlasio 3, acto mogakarybloste leuko (M7; + Mysloproriace negative + Common seen in Down syndrome patents <5 yoo of 396 aH FAB classification: Acute myeloid leukemias = Chestaton Name aston a WO | ate mle ar innay = send $ © ade melt: whet 28 M2 ‘Acute myeloblastic leukemta, with W920) = eee oa i a i= = . poe (ee =a foam ou :3 me atomylononacyc tara Pr) = oer, i = dektGa) 2 aveWS eee beeeuuNaayveeesercnas ava losiicaton we Ms. ww Nome ‘ate myelobaste laukent, minimal ‘erent ‘ete myetobast oukont. without ‘ete myetobas leuko, wth (enulecyic mauraton Promyetocyc, acuta promyolocyc oukerni (APL ewe myelomonocytclowoma este monobini laura (MSs) oF e80 monocyte lac SE) ‘cate crytold outa, ncing eryoleukeria (6) nd very rae pare ‘nate IMSS) ete megakaryoblsti ukemi Mutavon 1829 (2422, 163) ws ns) razz) ont eter, ae. ‘osstcabon 022)rmonccytc loam MSD) ea, assfcaton Mo. ‘hat ertold eukomins. ncn ‘ntloukema (59) nd very ae pare ryan 6D) w ewe megakaryoblaticloukenia 1122) ‘Option A: Aes mogataryblasc automa commacy sean th Down _symrome and in patents <5 years of age. ‘Option B:Myelodysplscsyncromes may develop into acute monobasic leukemia or acute monocyte luke ‘Optom: The aecumuiaton of Ae rods canna othe development of ‘lssemnate invavascutarceoguopay, which sa commen cause of ath ‘Option E: Philadephia cromosome can be seen inact ynphoblastic ‘oukoma (AL) ad ehronie myo ukemi (EM) duo toa 822] togonic oral ants indcatv of peor progesis. mn corvat vanslocation {1.2 ural ate of» good prognocs. Acuto Wmphooyt Leukemia (ALL) sebsorvedin cron ith Down synciome eatyin ha fe since mo ‘mutated genes nthe 2 chromosome, and Dawn sycome patents have an ‘oa copy oft Leaming objective: Ace promyelecytc leukemia MG) a subtype of acite nyo eukomias that occurs duo to a7 mutation tat mpars the {uncon othe retnoe acid receptor which erfoes te matraon of ‘promyelocyes. The managemers const of atane ett a (ATRA), ‘rch reacvates te retro acd ceptor and teteore cause Hast BSc tt WS eee beeeuuNaayveeesercnasWS sec beeeuusaaruyeseessal ‘A 2tyoa-ldcologo stent is adit to the arergency department with ‘complains of phrynats headache. and a perston non preducv, cy hacking ‘cough. The patent complains of eting ted and figued, and cenes fevers (On piyscalcxaminatn, her mucosais pala. complete hood counts remarkable {or decreased hemoglobin. The phicion suspects ral preumeris, bute sputum ‘ature tests come back wt the flowes descnpton:hed-gg shaped cleres on Stojo-contaning media, and mulberry shaped clones cn media cnting seo! regina the compton associated wis Mycoplasma poouonoe? © A Red blood cts bind tol in warm temperatures > 37C > 9867 (© Sits stan assoctetea wh inectous mananucest Treatment consist of MI. 0 Annet Coombe tetas poste, © Retiood calls nd tog in cold empeatwes < 37°C (< 9867WS sec beeeuuNearuyeseessal ‘A 2tyoa-ldcologo stent is adit to the arergency department with ‘complains of phrynats headache. and a perston non preducv, cy hacking ‘cough. The patent complains of eting ted and figued, and cenes fevers (On piyscalcxaminatn, her mucosais pala. complete hood counts remarkable {or decreased hemoglobin. The phicion suspects ral preumeris bute sputum ‘aftr tests come back wt He foloweg description: Wed-gy shaped coors ‘on sterotconsning media, and mulbery shape colonies on media containing orl Adtet Coombs tot comes bar postive Wich of the folowing Statements fase regardng the completions associat wth Monte © ARodblosd cots bindtelgSinwarmtomporaues> arc a 30, 15. smary associate wth infectious monerucec aie _.Aninret Coombs tet wil be postive. £ Rod blood css bint gM in cold temperatures <37C { 9BBF). 26% Result: ea Valo}Explanation: Related Videos: {Comat answer Tis pions prserting wi lass ltr typical Cott immune Hamed Anemia CAN: cogy Patoganess and ‘pneuronis caused by Mycoplsa preumonize. Cold aaghnin hmohtic © Cttetcony a ‘nama assocted wh infection. Mycoplasma preumanice hs rea) oe astagusingfeaues + has no ce wal, his why ts not sestve to penein ” = » = + Fed.egg colores ae seen in Eaton's mec + Mutborshoped clones ate observed in mea containing tle First Aid References: a + Posto col agaltinin est ect or ndeect Coon tex). Fst Ad forthe USMLE Step 12019, 28h 45, ‘irscaly M preunonie fection can be suspected fa pant presents ws Fst Afr the USMLE Step 12018, 2h ot + Phormis Fst forthe USMLE Step 1204727 ed 401 + Lite sputum prstction + Young nant = + Hacking cough aylooks worse than the patent symptom ‘The nection canbe managed with entromyein,athromyein. oF lattromyein As mentioned, cephalosporins of peli wil nt be efectve” » Me econ canbe managed wih ervemyet. sihroryer oF Clabvomyein, As mentioned cepalosponns of pele wi nt be efectve ‘ince those medicabons at by loping the celal grow, which saben ths orien, ‘Options 8c, D, and E: ll are fates ood agin hema ane ‘Both warm and cold hemolytic anemias canbe managed with MG, bute causative agort aos, 96 fC erparme Cnn | Insc sn col epee a cca tera tt, iene oe epee rch Bete eo er ESS Loaring objective: Mycoplasma preumorice isthe most common cause of typi pneumonia in young cae (cage nts nd maitany Detsonne ands wansmfte by espa dope gNncited enune emetic anemia ean accu secondary ts inectons due to Myeoplarm poeumonie an infectous mononcleo sto tSWS SsebeaeuuNzayveseserss ‘Tyee boy wit sate oat. ove and generalized malaise 's anid oho edie foor On physi examination. he hs fice white exo on both tons ‘nd aoa papabl spleen with mid hepatomegaly Hs blood smear shows age and abundant mphocyts wih uo-gey copes, regula mic nd dak ‘romatin with inconspicuous nul, Which of tho flowing the most sly tagnosst © Afectous mononucleosis © 8 cytomogaiowus infection © C Towopiesmesis © D.craves asease‘Tyee boy wit a sar oat. tov and generalized malaise saad to ‘the peda fot On physi erarinatin. he has use white exudate on both ‘ons, nd > papabie spleen wth mid hepatomegaly He lacs emear shows aig and abundant phocytes wih ue gray cyoplas reser rucok and dark cromatin wth inconspicuous ruceo Which of he fllowing is the met ily stagroset poor eaaray Ps — 8.cpomogsou recten x 7 © C.Toxoplasmosis ~ = 0. raver seate ~ x vent opts ® 2 Result: en . @ reno an in Explanation: Related Videos: AGSWS see be aeuuyzaveseserss Lesva Explanation: CCenect answer A: This pation mos ay has ifecbous mononucleosis ith ype lymphocytes thats caused by sien Bat ws. The patets usually hve 2 sor throat fev nd fatigue wit nudsiv tones, Tho vera the spleen mgt bo erage. The prphoal blood smear shows abundant typi mptogtes, Lymphocyosis is an able esse of> 5.000 cells n adults o> 2.000 con neiaon ean accu wth pica ar atypical mpgs. ‘The mechanisms for both ypes are dsincve. Grave’ disease or Basedow's sease on aoinmane simulated hyperhyok condiion On Mstoloey, yp ois can be found the ty but the pecs assorted a thes folcles are typical looking (Choice D. ‘ypcaymohoerols can be fund culating a peripheral blood orn meh ‘odes sna other harp sue Thats calle are rather salt open lock ‘ace’ vometn and abundant cjopas. Ayia ymphocyoss, aso known _35 resco phos lok toubing but are benign. Atypical or reactive Iympocte ht may be ebeeved in infecous monanoclsoe der ‘morphologically by having promentnuceo and abundant ue cytoplasm ‘th ezasona vacuoles fete the image below). They ae asa smal han last cells Malgrantmeho Fst Ad forthe USMLE Sep 1 204727 e161a thes ols aro typical looking (Coles D) Sera ‘ypc ynphocyoss can be found culating a poiperl blood orn gh ‘odes and other hmphid tissu. Those ells are rater smal wih open lock face’ hromatn and abundant cytoplasm. Atypical Imphocyoss ao known 2s rect phocytes, ok toubing but ae benign. Apical or reactve Fst Ad forth USMLE Stop 1 2017 27h od 161 : era estan Sd a tr mn eee a erode reir Se) Sit sirmmsnets nna ML moong Le O86 5204.05; 50" sim) CEE aR Seabee h LE TURNS a 2 o0ee sera one - ° = Sos OROnpaNEeS, sasBuaapy3 ao9' 28200 & "O80, Bo e 0° ite. : Viet menenuctons Inlcons: rence i Gperegsintes al neat, sacra sori, oes : Madeston pnp terscioe Maden: renga . ert WS see be aeuuyzaveseserss eaeWS see be aeuuyzaveseserss Meseaton pram terejeine ——-Madeason sent Ieplado ‘Option: Aenaugh paons win ytomeguovus nection may ao Rave type Immphooytes usualy is Hfecon 's symptomatic in lnmunecompotentinciduas. ‘Option C: Touopisemne is nly an opportuni nection snd ay ae congenital fectons fa pregnant woman exposed toca fos. typical Iympoortesisis seen intexoplosmonis 2 wall (pon D: Gravel onae is neo i est common eases cf tytn, Patents usuoy preset wth woe os, exces swesting, palpation, Meat Imolerance,atgue, et. Ahistry of sore troat wah fever anda pial ‘crminaion cing of dative tonalite we mere suppestve of nec ‘mononicecss ‘Option E: The patens with vial hepats may have atypical hmphocytos but ‘hey usualy present wih jaundice, atgue and aero. They donot have @ ‘Loaming objective: Aypcaymphocytos ae reactive phocytes responding toan efecious agent whichis usta its Morphology, thy hve ‘Prominent ncleol and abundant lve cteplasm wth oecasional vacuoles. “Tey are aleo sate than blast cets and ater magne phocytes. LesvaWS se ebeaeuuNsayvEsesees| ‘8 0-mom ol oy i ing wostod fo arate Kind a enema and is candy beng ‘vluatd fo bone marrow transplant The paint mother comes 1.7 {appotnment wh ter pelatrean afer having dene some one essarch. She has loatned that the majtty options noc coaion as en auosomal dominant mutation, Asa esl of the gone must, theo fsimpaied enthopeieis, leading te macrooytc re blood cals witout hypersegmented reutopis. She aso ‘ead nat cate who sue wil eventual present wih shot sate and conn? © A Splenectomy ca estment opton (© 8 Occurs to an nai to convert rai aed tina ‘monephosphate UMP] {Fetal nemoglbin evelis elevated © D.caus veto aut-anbodies agans ho patel cls fhe stomach © € Occreduoto.a detectin ymphoblass an nro progenitor‘8 0-mom ol oy i ing wostod fo arate Kind a enema and is candy beng ‘vluatd fo bone marrow transplant The paint mother comes 1.7 Sopotnment rhe peiatenn ater hauing done sma anne eesorh She has cared that he maja patios mors conden as an atosema ‘dominant mutation. 8 rest ofthe genetic mation there is impaired erytropotets, leading to macrocye res blood cols wit. ypersegmented eutophi, She ao read tat cntten who survive wl eventual eset th patent's conan? = [A Splenectomy isa weament option 198 {8 Occurs ue to an nay to convert rai acting 2x a monophosphate UMP) Fetal hemoglcin evel levatac 2% 1. Ocaus dio to auto-anibedis against tho prota cals ofho 5% stomach Ocrrs duotoa detect inhmphoblat and entoll progentor 26% Result: WS se ebeaeuuNsayvEsesees| Lesa” = » = Explanation: Conc now This ont suf om Daron tckon nei DBA chin oree pent ore tt ely preva rerts eFyeer int some etn Th metre btn eee inde eect oped opr Cte fae venesredthcos crs are mao ‘aout ipesognened putopis Tiss coer o mepaasc teria share eae ws pwoegnetied aA Diag aan + troy neath 9 estat toene + iaveunter cfrdodogtee + imal mart conan wn patchy trl pecs + te noma bt pee enroute jr supering grote citer or ssi OK + tdonincaton ot pathogenic vat nono ofthe gones known tobe asscited wth DBA Related Videos Diamond Scion Anemia EME} First Aid References: Fst Ad forthe USMLE Step 1 (2019, 2h e412 Fst Ad forthe USMLE Step 1 2018, 280: 408 Fst A forthe USMLE Step 1 (2017, 27h ec 398WS se ebeaeuuNsayvEsesees| normal marrow clay witha pauctyofred cell precursors + oar normal but vai, neue ani ple! cours Major supporting lagnoste citer fr classe DA + tomcat of pathogenic vat nono ofthe gones known tobe socited wth DBA + family history consent ath autosomal dominantinhernce ‘Minor supporting agnost citer for clesse DBA: + elevotes ernie adenosine deaminse (28D) + elevated HOF concentration + one or more congontal anomates dsaibed a clssie DBA + no-eidence of another inherted soda of bene marow function DBA ncosses the rsk of th flloning soos: + myslodepsie syndrome MOS) ich sa ord ood cet fal to develop nermaly + acute myeloid leukemia Atl) ‘ious S0% etna wth DBA have physical anomalies. They may presen wth + microcophoy + hyperolorsm, Le, wisest ears + plas road tet baapoof me nase + microgethio + cot pate + teptalangea tans sto ttWS se ebeaeuuNsayvEsesees| ‘Aion 50% etna wth DBA Nave physical anomalies. They may resent wth + microcophaly hypertlorsm,L, wce set ars losis broad, at biage orto nase microgathio ef pate ‘webbed neck tmpholangeal bubs Non-megalobastic vs megablastic anemias Non megaloblasse Megaobiestc NA unimpared pated ‘thesis Senin Livr dscns, alesholsm, __Flat datieeny amin BI2 Diamond Blacitan anemia dofncy ort aciua Findings | Red Hood calls aremacrocle Red blood cals are wenoutryperscemonted——macroeytewn rnewwopis hypersegmented netophis ‘Option A: Splenectomy isnot a teatment option for DBA. ‘Option B: An nality'o convert fc nek to UMP eae ore esa, 9 LesaWess reeeeuuaaavesesees| Nor megalblasic Megaobiestc NA | unimpared pate synthesis Seenin Lior seas alcoholism, Folate deteieney, aman B12 Diamond Biacitan anemia defcncy, ort cia Findings | Red blood cal aremacrocte Red blood cals are wenoutryporsagmented— macrocyte wh rnewwoohs hypersegmented nestophis ‘Opton A: Splenectomy nota treatment option er DBA, ‘Option B: Annable convert tei okt UMP ene oe eas, 9 cause of mogloblaste anomia ‘Option D: Perncousanemiais he most common cause of tania B12 the stomach. mating nts factor production. and ts, he absorption of \tamin 12 Viamin Bi defclency ests na meglobaste anemia, ‘OptonE: DBAs caused excushely by a delectinentold progenies, patlympnebiasts a wo ‘Loaming objective: Otamand Sckten anana (O8A) can bo iertod 3s an autosomal dominant deoae9 ot ese duo to 9 maton the ROS, GATA, oF “Tk genes. Patents ae ely in thee year fe ana preset wth ‘mactocy anemia, elevated HF, and ow numbers of ecules. HctBeebe beeeuu Naar uses eel ‘A paton presets ois pay care physian wah compas of equa headeches and upper abdominal pain. Onpyscal examination. Hs pln ad ver ‘20m enlarges nl face peta, Gaeroandorcopy reveal eaves one cos raging em 5-3 nmin greatest dimension A bone marow aslo shows hypercolularty wt fri nd serum entropoiatin iow. The paint interme aout anew restment wth aon othe mae cau of he Symptons, Which ot ‘the constons below can develop due the same mation thats eazy ths 1. cite monocyte leukents © 8.Marte cet phon © € chronic myoiogencuseukomia . Bukit imphome £ Essential trombocphemaBeebe beeeuu Naar uses eel ava ‘A paton presets ois pay care physian wah compas of equa headeches and upper abdominal pain. Onpyscal examination. Hs pln ad ver ‘20m enlarges nl face peta, Gaeroandorcopy reveal eaves one cos raging em 5-3 nmin greatest dimension A bone marow aslo shows hypercolularty wt fri nd serum entropoiatin iow. The paint interme aout anew restment wth aon othe mae cau of he Symptons, Which ot ‘the constons below can develop due the same mation thats eazy ths 1. cite monocyte leukents ‘Mantle cet phoma © cvonic myologencus txukcmia . Bukit Imphome Baas £ Essent trombocphema Result:” = » = Explanation: ‘Comec answer E: This patent sues tom poyeytema ver PV, PV ia ‘neoplatc zonder with deregulation of myo cal dvelopment, ‘pedal fed loos cals. caused by 2 JAK2 mutation in chromosome 8. (Other dscases that ae ao associated with JAK2 mutation indude esse ‘trombocyinomia and ceenc lope mslofxos Patni wh PV lassialy present wth bury wsin, headaches fused red fae, hing afer ‘bathing and hyperceldar bone marow wih Aros tte tages, These allots aoa anincieesed sk for rambo vers. A lagna ca Bo ‘onfemed with fest for JAK2"" ration. Management consis of phlebotomy, hycaxyutea or woltin, 3 JAKI and JAK 2 to. There ae ‘ber pateymemas hat we nat ted to JK mutations Potyeytoias Relative Plasma Redbicod —_Nochango calmass Related Videos: Myoloprtfratve Dzcaee — Hematopoietic Mainances and Aplaste First Aid References: Feat Ad forthe UEMLE Sep 1 20%, 2904 wh 25 Fst A forthe USMLE Step 12018, 28h od 421 Fst Ad forth USMLE Stop 1 2047 27h od 11Beebe beeeuu Naar uses eel ava hebotmy yeoxjues otal, 9 JAK! and AK 2a There ae ‘er podreytomas hat nat rte to JK mutations (it dtr re Ep | G28) 8 0 2) Fst Ad forthe USMLE Step 12018, 28h ed 421 Potyeyboias Relative Frat Ad forth USMLE Stop 12017, 27h oe 1 Plasma Redbicod —Nechango callmans ©, sauration No crange eywopoletn No crange level ‘Associated Dohyetation, buns we ‘Appropriate abclito Plosma ——_Nochango ed ood colimaee Ogsauraton EnthopoietBeebe beeeuu Naar uses eel ‘Appropriate abclite Plesma ——_Nocrango volume Redbiood 7 slime O;souration 5 Enthopoietn + vote ‘associated COPD. jana congental heart esease, hgh ate wah Inappropriate absolute Plasma Nechange volume. Redricod > 0; sauration Ne change LEtopoletn 7 ‘Associated Duet ectopic production of FO. Seen in renal cel wen cacioma, heptocoulrcardnoma,Mysonapvesis sto ttBeebe beeeuu Naar uses eel ; saturation Nocnango Enywopeietn + ‘Associated Dupo ectopic plosucion of EPO. Soon in ronal cot wh ‘cinoma, hepatocolrcarchom,hydronophsis Povyeytemia vera wolune calms ©; souration No change eywopoiets levels Associted JAK mutation wen ‘option A: Act money ukemi (AML) a subtype a cit Myoltd eukomias known as MS bythe Fonch-Amovian ish FAB) lesion system Ris often sen a progression ofmyslcyspleticsyncrome. In AML, ‘hates on elevated numberof abnormal premature mye cts ast cal) ‘let cots ako p> 20% cf the bane marrow, speci of moncblet, wich Initrte the sén 39d guns Unik other ao myelodlevema, no aer (SaBeebe beeeuu Naar uses eel ‘option A: Acute money leuk (AML) subrypo a ett Myolid leukemias known as MS bythe Fench-meian-itsh FAB) essiieabon ‘system, Ris often seen ae a progression of mysloyeplcicsyctome. in AML, ‘hares an elevated numberof abnormal romania myo cle ast cal) lst cets take wp > 20% ofthe bone marrow. especialy of monoblats, wich Inflate the sin and gums. Uke oer ate myeloid leukemias, no aver {ode ro scen. JNC2 masons ate not soonin MB. Tho above pt present th casi smptom of PY. hich elude ruddy plthafoce dv © vessel Congestion anda decreased serum EPO lov. ‘Option B: Marl cal ympoma MCL avery aggreswve rare orm of Bl an Hodgnymphoma atmos afin afecs nen ove the age of 6, ands _scociotod wah atranelocaton 11) The fusion of enzyme cycin Dt and bay chang. MCL is usualy eagnosed a late stage seas at usualy spread tothe gastintestn! vac ond bone meron, Chemotherapy renal themantostent option. AJRK2 mutations notimptestoa in MCL. ‘option c: Chronic myelogenous eukemis CML] occurs ave te aneplaste ‘onal expansion of plrpetent stem als de oa ansocation that eas 0 ‘hotrion gener BCR and ABL known a the Dhiedephia chromorcene 18.22} Common thangs nckudo wag ss, tiguo, and sptenamagay. Tho ‘bone marr hpereliar wth markes myles pertain, CM. Wea wth matin mesa, an ofl resine Kinase nib tat has a good ‘rogonete reponse wih more than 7% of pons, A JAK2 mutation not ‘ssocated wah CML ‘OptonD: Burts Imphomais a Bell non Hodskin hmohoma that hes been _secocatedweh EBV and 6) The Acan type ofthe eae csseaty fects the jaw. we tie American type nomalyaets he gastrtestal leat ond par. nrtic nodes. A bop of tho tut has alse try sky LesvaBeebe beeeuu Naar uses eel ‘Option B: Mare cal ympoma MMC) a vay aggre ara orm of Bl ‘or-Hodgknimphoms that mes fen afects men ove the age of 60, ads ecodated wh aenslocation tt) The fusion of enzyme cylin Dt and ay hain. MCL cual sagnosed asa ate sioge dseaso at sua spread othe gasointestnn tact andl bone moron, Chemtheracy reals ‘theman westment option. AJAK2 mutation notimplcat MCL. ‘Optonc: chro myelogenous eukemis (CML| occurs duet aneplasic clonal expansion of plupetm stom cls de to atansocation tat leads 6 tho fusion genes BGR and ABL known as the Piedphin chromosome: 19.22} Common fndngs nckde wag ss, fatigue, and splenomegaly The one martes hypercelay wah marked mycoe yperpla.a. CMs Ueated hima mesa, an ofl reine Kinase inhib tat has 9 goed ‘Srogenetc reporee wih mote tan 75% of patent AJAK2 mutton not ‘Option D: Bult’ Iymphoma ea Bell non-Hodgkin hmohama that has been associated wah EBV and 1, The Aiean typeof he seas css fects the ow wile te American type nomaly afets he gested ‘Vac andpar-artc nodes. A lope ofthe tumor has alas tary sy” appearance. Chemotaapy she masa of eatent for is de0ase. ‘Loaming objec: A AK mutation chromosome 9's associated with polyothoni ver, exert! thombocsthomi, and cron opate ‘ysttoor. Rolin snow JAKI2 mbar hat cone vento Westsafes: We seebeeeeuysayeees ‘to yoa-la git in prevously agnosed sicko col anomiaprsents toh ‘emergency room wih a for grade fever malase, petoctige on her rms, nd ash ‘on er face Se reguay takes nycrnjures and recaves lod wanrusons to vest hor condton. Hr bcod ests show anemone of 40 gal, MCV of 871, and 7% roticloote cont. Ar atlemptod bone marow biopsy was dry. mpty tap. Whats the most hey agnoss? © A doiestc css © 8 cacworostia bieeang © C Aneminoftroncdsease [© D1Resctonto te blood wanshsins © E Soquesuaton crisis‘to yoa-cta gt wn provoush sed ko col anemia prosnts oth ‘emergency room wih a fon ade fever malase, petoctige on her rms, nd rash ‘one face She requ takes hycronjure and recaves blood vansusons 0 ‘weather centon. He biood ess show ahemaxjebin of 40 gk, MCV of 370, and 28 retcleete court. n atterpted bone martow biopsy was dy. empty tap. Wats the mes key siagnosist 2 ‘ele as ™ a 1 castor cing * ©. Crumlin * = © Reortonto the ood wensisons *“ z sogwsiioncise wo ~ =| Result: = @ conc oo = Explanation: First Aid References: “= ava ere.‘W ” = » = Explanation: First Aid References: Comet newer The patent moe ely presenting th aplti ii Frat Ad forthe USMLE Stp 1 (2010, 29h od 168 secondary toa parvowus 19 infection, which sa complication commonly observed in indicat sik cll noma (SCA) The pavovis tacks ‘exybecbiacts and ter col progetors na patent wih SCA the quant of Fst Ad forthe USMLE Stop 1 (2017 27H ed) 60, 39,400 ‘tncloning red blood cess decreased cue to severe pancytopenia. Bene ‘marrow biopsy revs an ompty, ty marrow, hypocetdanty and Increased aposetesue The infection can be st. intng or may reuie 3 ‘ne matte wansplan and such patent, marrowstmuatng factors ae Fst Afr the USMLE Sep 12018, 28 e154, 409,10, Pavone Bo ° ‘Ane sa2ine mestcaton a — =‘bone marrow tansplon and in such pation, marrow stimuatng factors ao so ndcated, Other causes falas anemia ae shown below “ Eee ‘W ‘Option B: Gastontstnal bicedng prosonts wih epigastric pal. whic not reported inthis patient irene Gl bleeding canbe a cause often decency ‘Option: Anema of conic disease occurs secondary to rheumaton arth, SLE, neoplastic darders and coc idney deca, ‘Option D: An adverse eacton toa Bod tanstuslonts observed shorty ater smo procodue, We seebeeeeuysayeees ‘Option E:A soquestation cis sot seon at isnot paint because ‘hore ae symptoms of an infection an the bone marrow sap ndeatve ofan alas cr Leamingobjacve: Sk cs nema patents are aris for alate anemia Infected wth panvovins BI, whlch tac entheablests and the celWe seebeeeeuysayeees ‘Option B: Gastohtestina bleeding presents wth epigatc pal hich not ‘pst ins pan. Crane Gi becang can be a cause fon decency ‘nton ¢: Anemia of crore deease occurs seconde to rheumatoid att, SLE, neoposte dlcrders, nd cronc ney ace, ‘Option: An adore eacton 13 bood transfusions observed shorty ater te procedure, ‘Option E:A sequestration ci sot eeen a heme inte paent because ‘are ar symptoms of an infocton andthe bon marrow sepa ndeatve ofan alate cr, Loaring objective: Sele cel aremi patents area isk for aplst oem Infected wits pono BI, when atace enthobiets ane ether cel precusrs causing pancytopenia, Sono marow Madnos ee helpline ‘agnosis ofthis cmpleston and are clara doscrbed as nt empty oP. Marrow stimulating factors and blood marow transfusions are treatment cptens.| HctWe seebeeeuuyaayveees ‘8 28,yoaoa woman camo to the emeagency doparment ae to sovresypoms of txtaton and uneelobe cariaiions. Shes accomparved by her husband “wn report tht she ake delta, Ther sno pro psreanl and amy ety ot pps Sho shows srs ef contusion hypoctablty, and asorontation.On ‘unter ovation the paint is noted to hve stoma, lost, and chal. A ‘chest s remarkable, The decency of whch ofthe wai olw fel 10 be me major cause ofthis pane’ symptoms?‘8 28,yoaoa woman camo to the emeagency doparment ae to sovresypoms of txtaton and uneelobe cariaiions. Shes accomparved by her husband “wo reports tht she ake delim, Ther sno pro psreanl and amy Neto of eplopsy_ Sho shows iors af confusion typedetabity, and saosin. On ‘urthor ovation the paint is noted to hve stoma, lsat, and chal A chest Xray suremarkable, The delency of whch ofthe wins below fey {tobe the major cause oth patert' symptoms? We seebeeeeuysayeees” = » = Explanation: ‘corect answer E: islam stake by parts that sur fom alcoholism, vrcnis also thy to present wath pti defiency (8) Outram ‘works by inhibiting acclldchydo dahydrogonaa, andi can causoa sere ‘vy te patent intakes alee ‘The symptoms ofthis patent coreae wh the incl picture seen n BS defen, which incides: convuison,hypetiatity, peripheral neuopatiy, -Athimine (8) deficiency lo commonly seen in alcoho and ‘mahexrened pots. The hallmarks of beth Vitamin B éefcencis are ‘Viamin detlencos sean seo a o Noma! Theprosust le conveted to pyridoxal phogpats, > ‘hncion —thamine colar to tansamination, decaraxfaton Dyrephosphelerexchons, end gycagen phosphorysse. Ea cotectorfor_Synthoricofeyeatenine, heme, cn several stamina, eotonn, epnephine Related Videos: ‘Yarn 83, 85,8008 87 First Aid References: Fst Ad forthe USMLE Step 1 2019, 29h 67,72 Fst Ad fr the USMLE Sep 1 2018, 28 oh 62,72 Fst Ad forth USMLE Step 12017, 27h 63,68,sn defeincoe een Fst Ad forth USMLE Sop 12047, 27h od 63, 68 a cy ‘Nene | hepioaiet | W covered to pital phcaphata a funcion thiamine cofactor to vansaminaton, decarbonation Djrophospnaterexcons end aycogen pnosphonEse. coactor for Sythoss of eytthioine, emo, acm, soveral -nstaine, eotonn, epmepione| . ehycogenase norepinepvne dopamine, GABA ‘enzyme Deficiency + Wericke: Mostconmon delet co to bona Kors terapy to reat tubercuoes. syncrome + Dy berber + eer “pertbert detec ‘Conmutsions penta, prpheral peropaty, cerbiaticanemas, ‘Alco noseaton canbe act of chron ate alcoho intonation resent a dinhibon,amtonal abit. tured speech. gat letrbances, Dlackouts and coma, adaton, AST > ALT and serum -gamytranterses ISD i ncrssec as of wich asa marr ft lhl odie We seebeeeeuysayeeesdei" [Alcohol noseston canbe asi chron. este alcoho intention ptesens a dsinbion,omtona abit, sured speech. gatdstuances, blackouts, and come, action AST ALT and zeram V-laameansteraes (Gomis mcreaced; theater of which i acerctve marke fr alcoho bane ‘Chore achat abuse loads to many He-teatering pathologies nding eptocelulrearnoma, esophageal cance dated cacionyopathy, and BS ana Bt amin doteiendes Ler etuncton resus malonate Stestohepnts This condon can resat na seof coagulation eneymes a ‘unin, ‘Options A Vitamin 892 tlt} and vitamin B12 deloncies eadto ‘macroeyic mogalotesicanami, lao dations pu he otis a sk or extl ube defect Testment consis of replocoment therapy. ‘Option: Ribotvin 2 defcieny causes chokes and cones vastfrzaon which are the 2 Cs of 82 detkioney: ‘Option D: Niacin 3} elon causes potagra, The mnemonic"30's of BS apt o remember the symotoms ofthis condone. area, dementa, and dormats) Ris teatod wh hgh peti dat and neste ace, Nan S {ed as amedicton to eat cea kinds of yapcerins Learning objective: Chronic sleholsm an lod to 88 and Bt vin efiiencis. 5 decency can present wih convulsions, Pypermtabshy, perphora! newepaty, and sierobastic anemas. Dulas the cu of choles fr the trestmont of chon leat, Bch tt We seebeeeeuysayeees‘yea boys bong valued or toto belo and bad petomence at choo He has @ istry of lero anemin ar tks mlivarsn every morning ‘wih reatas An elecvophorees nals shows no HbA, elevted HbA2, and hormal HBF. lal ay rowoaod a croweutappoarance, Which o fo fling ie tho most ely agnosis? © AHH ceooee © Baatvatt © D.Bthal major ensnar © E palmer o : x =ensnar o : x = ‘yea boys bong valued or toto tele and bad petomence at school He has a history of micro anemia and takes 8 mularin even rmomng vth resist An elecopheress ana shows no HDA elvateé HbA2, {and noma HOF. Asal say fovealod a coweut appearance. Wich af me following is the mest oly gnosis? 1 Hoe cooee Bamana 2. Bho maor ptralminor a8eaH Resul Explanation: ‘corect answer D: According oth slacvephoress an Kay res thi boy Related Videos:BoB BOBASE. ° = » gees Explanation: ‘Correct answer D: According othe elecvephoress ane Kray resus ths boy ‘most kay surfers rom Btaaesemio maf thalassemia major als ced (Cooly anemia hich an autosomal acoso severe form of thalesseria thot rests in a miroeylic anemia. A rewcut appearence on sll Xray sa ‘on spec rxg that ndcatos parstel acon to bone marion Pyparuopny in esponseto a vrs enema ‘The normal adult hemoglobin composed of? a-chais and 2 chase ‘Hoa 0282 Mutauons he nomogiein chan genes oad 0 mo production of ther pes of hemoglbe hat ae nota fective as he HA. ‘There are 2 genes that code fo the chin in chromosome ft Bahasa recive ito minor ana major rome. fnaaesemas are mora commenly Soon mnavauats of can and Macieranean descent. A means tat ‘hore 9 diminished producon ofthe chan while @ BO inccaos ‘comple abeance Th fi sande or Pahslaesnensa mins, and BB eB) stands or Bnalassaomia majo, In cooks anemia, te RACs have inusons and ae moved by splenic macrophages or undergo apoptsisin the Bano maton This can ad too ‘neressed love! of uncontgated rab whieh Is cncaly een unde ‘Since hematopoiesis not effective other bones and gan ave used as new Related Videos: 6 ‘Beta Thalassemia Cicl Pathology First Aid References: Fst Afr the USMLE Step 1 2019, 2th od 10 Fst Afr the USMLE Step 12018, 2h: 407 Fst A forthe USMLE Step 1207, 27th ed 397We seebeaeuusaayeeal 1B stands or Btlassaomia majo Inools anemia, he RBCs have incuser andar removed by splenic ‘macrophages er undoige apoptsisin th bane matron. Tis can fad toa Increased level of unceniugated blrubn which rca son as unde ‘Sine hematopoiesis nt effctve, ther bones and ogans ae use 2s net ematopaiot Stas, «gto speon and he Not which ate onl god in hese atts. A skull Xray has characters appearance ofa rewett 2 Pai ‘nen forthe 12 same eaten A compereatery increase mrtculoytes land ROM is observed The ony aalaie Veetmet for Cooly anemais@ ‘bone marow transplant of eric blood tanstsions, (Opn A: The dotect of 3 gonosis known as HEH ocaca The exclusive ‘torkion off cha lade to an nereored destruction of RECs by splenic ‘macrophages. Thala, severe hemyc anemia sya are crically ‘bsorved Ris also known eh fou Bch daos20 ‘Option: The dotoct of 2 gonos is known as atassonsa Walt and gos ‘re toa mild anemia witha norma to merensed RBC cot ‘Option: The defect ofl 4 genesis incompatible with Me an Keown 35 [Hb Bar alesse The enuesofniratenne deh ede to nycrope oa, Genotype Name escription 1 owe Stent gene carer aensnar o x = ~oae Bipot BB ‘ethalssomin ‘halecenio tholssenio ‘halsecenio miior ‘Stent gene carer Mid crore anemia More in aeons Mid mcroyte anemia Merocyte anemia epainptancety [Esematoue nebo ‘Sbom: yrs ota (-Tholssemie 6 ‘tolsesenio Merocyte anonWe seebeaeuusaayeeal mor B-Thalassomia 1 pmo Be Mixosyte anemia BX maassomia 2 BIB B IMerooyte nomi BB taesemia Occasional ranstasons 3 pk Severe anemia hepatosplenomegaly, mjer by theage 20 ‘Option: thalassemia minor i) preent se ag amd mlcrooyte anemia (Ge pairs prosent with docroasod MCV, HD and Hc). Tho RBCs wil bo ‘ovate leads to an MCV/RBC roto <19. Ona blood moar target cls ond ‘ererop RBC: maybe een cu to elene matephage deeriton. ROW Vo ‘ze dsbuton of RECS) an forin ae noxmal. Theo's also anormal range ‘of serum oe env protoporphyrin FEP which san inleatr of emalyse whan eevnte -ehnine cel pokicad uti as an noma ‘This compensated by an netoase in HbA2 and HF. HbA Soon ths ations sorum anos Leeming objective: Talaasomi ar divided ine cer according tothe fective gene Btolassemia majors one ofthe most severe forms ofthe ‘sease. A defectin te four chain gone leads oa severe hemelic sto ttuf slo = oo We sereeeseua aay es ‘A S7.yea-old woman prosors tothe clinic wih a mann tory of sing bgt red blood nthe tlt ator defecatngAddhiona complains inde fies. Shoress of breath, nd mld thargy She denis the ss of weight abdominal pan tor changes in dletay behav Sho coneunce a Balanced ct and akes mula \amins everyday The curent wl sigs inckde te olowing temperate 570°C (806, pulse ates BRN Hood posses 13018 mn Hg. and the respratey at nin. On physi examination, you atc Increased castny ‘ef tine ard ple mucoes Wha re the mos ly ning er erosion, hemstert, ed blood cal cou, and mean corpuecar vom? ‘A Hemoghb | bent ed od cl court mean commoner? Hemet bette Bod cel canon epee omoghon Pano. od eal cour. aan Sener coo ia eene concnereieaet eae}uf slo = oo We sereeeseua aay es ‘A S7.yea-old woman prosors tothe clinic wih a mann tory of sing bgt red blood nthe tlt ator defecatngAddhiona complains inde fies. shores of reat, and mld tnargy Sho denies theless of weight abdominal anor changes ndctary Benavi She consumes a balanced tae aks multiple vans cvory dy. The eet wal signs incl tho folowing omperatre 370°C (9.67) puso rate i im, lod pressure 301 men HH, anate respatry ae Tim Onpyscal examination, you notice incrasod capil rfil te one pale acoza What fe the most ay ings fo hemogebin hemater. ed bid call cunt and mean compuecutvoime? ‘Avenoghbi bento red bo cect mean 2 commoner? a Henoobi:tensct reba cal cout neon 40% epee © Crores hemabote ted oodeatcometiman 7x Seeterne sooaee EHomogtic| hanatct redoodcteamt neon 2 concnereieaet AGS er.uf slo = oo = » gees Explanation: Comet answer D: This pation having 2 Sent hstony of etl eons though many acre can care hematocrit paint pomsatons colon cancer shoul be the foetont ut proven otherwise. Divert, angioayplsia, ana hemouoids should also be onto drei ist ower han unio Hemoglobin wi be decreased asthe ROCs are pathologically ‘miller nd wil appear plein coor. Mean corpucculrvlume maybe nom {or stg elated ashe bone mains sumulted 1 lease immature reteset it culo. These retlostes a sh larger tan mate ‘ee blood eal pushing the MCV higher As og as the ron sts are ‘martaind, her body wil tomo to compensate fo th cen 00d loss. ‘Option A: Chon bio lass eau in anemia wth asso hanopabi as ‘nero ‘Option B: Hemstocrt is the ato ofthe vetume of RECS to the oa wokane f ‘lod. The woud be derensed due fo the chon lee ef blood beh inte ‘and oxrasoneulty. ‘Option C: REC count shea bo low in eases Fehon bod ss. First Aid References: Fst Ad fr the USMLE Step 1 2019, 29th: 382406 Fst A forth USMLE Step 12018, 2h 352,406 Fst A forthe USMLE Step 12017, 27th dh 37%, 386uf slo = oo WSseebeeeuu Neary ‘male nd wil pp paler coor Mean compre viene maybe Nom ‘of stg elevated ase bone maton sumulted 1 lease immature feteneyies rt ctculaon. Those reticulocytes ae aight larger than mare ‘ex blood els pushing the MCV higher As ng as the Fon soe re ‘mabtaind, he body wl tempo compensa othe cei Blood les. ‘Option A: Chronic boa lees eeu in anemia wth alse ofhemoabin ae tect osu Thettore,hamegloin eve: Sno bo decreased instond ot ‘nore ‘Option B: Homers the ato ofthe vtume of RBCS tothe ota olan of Dod Th would be ecrenee di tothe chro loes ed bot ints and oxrasesculty, ‘Option c: REC coun shea below in eases of ehonc bod ls. ‘Option These botatoryfndngs to. ncrease in homeslobin.hematectt, RBC court, and MCV) cous possi be soon in a patent win massive ‘wasfuson of packed RBCs, butts would not be the correct option nthe sconatio above. Leaming objective: Patents th even bleeding have dectensed blood volume .., hematott, RBC volume) Nowove the mean cospuscula volume may be elevated due to an nereaee in reticulocyte production, Retculoyts wl be produced to compere forthe bcos loss a long = Hctpsecsnar eeseebeesuyazay gl ‘A 57-year-old women comes tote cine complaining of pogtessive fatigue the post 4 months, She noid tht she is felng nczeainly shor of breath ater ‘waking the same dance fromthe bus sep to her Rome. She denies chest pan Syncope, ower extemity edema ofa cough Sho denis icy bowing Who sing comfortably but she has increased ticity upon waking or ohor milly "tran sett Her pet medal sory icles mid osteoporosis an occasional gastrerefux dsoase She takes ofl omepazce 2 needed and a aly tty npn, The patients evened accorded nd Goins rcking Klong bu she ‘oes admit Yamal ss of ed wine day forthe pas S years Her det consists of ‘aMeqterenean det hat cudes tls, vegetables, and sh. She sates het she has oon very holy previous and managed her onmbeath thou a pysican {or the pat 20 years. On physical examination, she has a blocs pressure of 12872 rm Hg apse of 87m, en an oxygen saturation of 94% on oom ac HEENT ‘xara demoncrates mi conjunctival pall Lung and abdem xarnains are wthn normal ins Heat examination reveals 326 stole rmurmar athe ght upper sen border. “The feowing laboratory values are obtained Hemogitin Mima Prstcete 240.000! inte Hood cts ‘000mm? nats Be mst hey rtcloyte ange fr is pasion? eal}psecsnar eeseebeesuyazay gl ‘a Meatorencan dt hat nudes tls vegetables, and sh. Se states hat sho has boon very helthy previous and managed her own heath without a physician {orth past 20 years On piysicl examination, she hae a loos presto 12872 rm He apse of 87m, en an cxygen setton of 94% on oom alc HEENT ‘eranatons are win orl ifs Heart examination ews 328 systole murmer athe ght upper sna border. “The folowing laboetry values ate obtained Hematsert 2% Hemagtia Mga Meon‘ed load olwlame 78 ft Poets 240,000) inte Hood ots 000mm?nsecsnas eesevbeesuyazay Lesva ‘a Meatorencan dt hat nudes tls vegetables, and sh. Se states hat sho has boon very helthy previous and managed her own heath without a physician {orth past 20 years On piysicl examination, she hae a loos presto 12872 rm He apse of 87m, en an cxygen setton of 94% on oom alc HEENT ‘eranatons are win orl ifs Heart examination ews 328 systole murmer athe ght upper sna border. “The folowing laboetry values ate obtained Hematsert 2% Hemagtia Mga Meon‘ed load olwlame 78 ft Poets 240,000) inte Hood ots 000mm? Wats the most ely rtcalcyte ange fortis pon?es leekisia rica slow ae = » gees AGS Explanation: {Comat answer Tis pallon sy ssf om ton deioney ania ‘bed onthe laboratory evidnco of microcode hemor eves ‘re normal plnsnts anced cal court Ane patent who resents wth unoxplaned Won datlcency must have acanpleto wok ‘de ok gasrontestnl masananey. though theresa possibly of Inadequate det or gaits rom cron NSAO te, aK colonoecopy shoud De ordered mmeaty to ecude a GI maierancy. Reteuleyts are recon syntoszed ted Hood ale synthesized trom the ‘bone marrow wth a daly replacement of 08-10% of he culating RBC ‘epulaton. ne heathy act, xytweldmarow nas the capabity 0 respond ‘omodorteanema wit 0 ys Tie nerease can be sen in both he poteantage of reculoeter (1 more commonly sen borat Bada) a5 wel asthe absolute reticulocyte count (amore deflate fact, ‘Option B: A decreased eteulocyte count ean be ound cases ofone ‘mar tae of decreased orytvopoleth acer The pavers surorng tom ‘moderate ten daiclency anemia rom extravascular bloods, eh shoud have creased retiocye cunt to replete enphroye level ‘Option: A decreased reteuocye cunt can be found in cases of bone ‘marow tare o: decreased erytvopotetn facet Ths patents sutering tom odorata ten deficiency anemia ron oxtavazaet Sood 123 on should Related Videos: 708 First Aid References: Fst A forthe USMLE Step 12019, 2th od: 10 Fat Ad forthe USMLE Stop 1 2018, 280: 406, Fst Ad fr the USMLE Step 12017270 396es leekisia rica slow ae eesevbeesuyazay ‘wth namal platelets and white blood cell count An eer patent who ‘resents wth unexplained on detlcency must have acompleto work © ‘ue out gastoitestnal makgnany Athough theresa possibly of Inadoquato ot feasts rom core NSAD ue, atl colanascopy should be ordered immed t exclude 9G malgrancy. etculcytes are recon snheszed red ood cals sythesizd ttm the one matte wt a daly septacement of 08-10% of he cetlatng RBC population. na heathy 2c. tro marow has the capably 0 respond ‘tomedovte anemia wit 0 dys. Ts nerease can be seen in both the percentage of tetulceytes 2 mre commonly seen aber Nag) a6 ol asthe absolute retcleyte count (amore dente factor ‘Option B: A decreased etculocyo count can be found casos of bone ‘moron are or decreases rytvopoltn face The pater suferng tom ‘moderate ten daficoncy anemia rom exravascuar ood 15s, end shoul hve increased reticulocyte count to replete eno level, pon C:& decreased etelocyo count can be found in cases of bone _marom fare o: deceased erytvopotth facet. Ths patents suferng tom ‘moderate ten decency anemia fom exravascda blood loss an should re ire ready ena reps eyccyte vel ‘Option: Nowmalteteutecto courts would ot be Soon unloss mo very ory stages of enemis nich te bone marow hes not had eno eo begin prosucton ofreicucyes. Leaming objective: Reco are the inmate precursors of aytvocies th eves inereasedin on deflency anemia due to the exvavasca ss Hct First Aid References: Fst Ald forthe USMLE Step 12019, 2th ed: 40 Fst Ad fr the USMLE Step 1 2018, 28 oh: 406 Fst A forthe USMLE Step 12017, 27th 396pesensnar eessebeeeuuyaay ‘8.28 oa. tao presons oho primary cae proc th an aching pain n hor tog that has progressively goin worse over several days Sho recent had {an urforunet portng incident esting in age bruises alg both gs and lower tits. An Xray acre event was nogatWe or Waco Past medical Sty postive fr syst pus erythematosus, She aso has 3 story of ne Sportaneous abortion 212 weeks gestation, Today et hea rates Onin. respratary at imi, bloodpressure is 19790 mn Hg, eed temperate ts 220° (8815. On physical examination, ho lee appours pik nd ght Selon Homans sgn poste. A Doppler ultasound reve thrombus the lef ppl! vel, He ab ests eas lows: Potelts 20,000Inm* Parl Tromboplostn Tine 90sec ang stay TT) a0s0e nats be most ily cause ofthe patents condor? 1 betneon darted nin pall yearn Me {8 arivodies drected agar phospholipids (Atbotes decid against endoteta cols ‘.wtamink dtisoney Disseminated intavaeculrcoagultion enspesensnar ee seebeeeuuyaay ‘8.28 oa. tao presons oho primary cae proc th an aching pain n hor tog that has progressively goin worse over several days Sho recent had {an urforunet portng incident esting in age bruises alg both gs and lower tits. An Xray acre event was nogatWe or Waco Past medical Sty postive fr syst pus erythematosus, She aso has 3 story of ne Sportaneous abortion 212 weeks gestation, Today et hea rates Onin. respratary at imi, bloodpressure is 19790 mn Hg, eed temperate ts 220° (8815. On physical examination, ho lee appours pik nd ght Selon Homans sgn poste. A Doppler ultasound reve thrombus the lef ppl! vel, He ab ests eas lows: Potelts 20,000Inm* Parl Tromboplostn Tine 90sec ang stay TT) a0s0e nats be most ily cause ofthe patents condor? | Benen darted nin pall yearn Me £8. rtodies dered aganst phosphapks Arbctes decid against endothela cols ‘.wtamink dtisoney Disseminated intavaeculrcoagultion eal}SOO neoooee eg = » = Explanation: ‘comec answer & Tis paton asa popita!tyombus duets yporcoaguation. This patint has antiphospholipid syndrome APS) perestey leate over of anode ected againet membrane ‘Shosphotpds i. aiicerdtpn atipnosphatiaysane or ho essocatod ‘sma proteins se image below). This 2ynome sore comon in patios ‘eh systemic ypu ermatosus and mares recurent ‘tvomboombalsm conpicauons such as deap vein hvomboss ad aborts. ‘The anibodis are agnstcarcoiin and non specif tsts for syphils such a RO, aw ah ahely pots, Pe mas APS ev pn eoaly ‘creased pata hyombopiastn tine thet wil ot avec wh mh Study. CCongulstion studies wth prolonged eats die to bars wl no corer, ‘rh ming sticks on eran of suet te hte by an boo, [APS then ne amount of erzyne replacement wore he doting ime. (ny coagulsion enzyme quay er qual issues willbe comectd wih 2 sng sty Related Videos: equted Trombae Syromos First Aid References: Fst Ad forthe USMLE Sop 1 2019, 20h oa 462 Fat Ad forthe USMLE Stop 12018, 28a: 458 Fst Afr the USMLE Stop 12017, 270 643= — ‘Option A: Autoabaces agnnt bia ao associated wih meno ‘tromibocrpenic purpura, dered as sled ow pate cure with normal Option: Anthodies against endothe cal lax o varus types of ‘acts, which produce fever mab, and spel symptoms dependingsive ana scls ewes uu a ee seebeeeuuyaay ‘Option A: Autoatbacies aga ba ao associated wih meno ‘tromocrpenic purpura, dered 3s slated ow pate cure with noma ‘Option C:Anthodios agit endotal cae ano vanaus types ot ‘acl, which price fwer mali, ad spel symptoms copending pon the vce esses, Open: A vitamin K deficiency reste a prolonged potzombin tne PT) stot corect wth msng ‘Opton E: Dtseranate inravascbrcoagutin(DIC| an extreme response toa severe cooguation imbalance the body Smal ember rough the ‘Small and medium vosos of th body tesuting in plolongod PT and PTT wih ‘ow pelts nd onogen eves The ests re often tal This tet doesnot appea' to have DIC Leaming objective: Recurrent hromboembolim completions sich ae OVT {ana sporanacus aborions in young female should aso tho suspic or ntohosphlip syndrome (APS), PT Ie paradoxical prolonged without ‘corection by ming study nd some nenepecite tet for yp eh 96 PR) wi be fatty postiveuvavecssax eeseebeaeuu saa ‘yom boy presents wi ocuront joint pan that migrates rom ont ont ‘and an itermitont ovr forte st several weeks, Ho aso says that he has no {ppette anc has bean losing weight. The paints afb, aval ins are wit hormal is. On pysical axaninatn, he's pale wt use potechia bloding and bruises on his eos. Abdominal xaminaton& sigficant fer epsteslenemogahy LUrascund ofthe abdomen conf hepatestenomegay and so shows mutple enaiged mesertaric ympa nade. complete bidod court (CBC) shows severe nema a hombectapora with oukocoos, Which of he follwing ithe mest aly dagnois nbs patent? © A peuteleukerta Asactc onem 1. mmuncogi trombocytopenie pussuvavecssax ee seebe eeu saa Lesva ‘yom boy presents wi ocuront joint pan that migrates rom ont ont ‘and an itermitont ovr ore st several weeks, Ho aso says that he has no Aappette ana has been losing weight The patient abl, ae val sigs are ‘nh noxmaltmis. On psc examination, ne pale wan ctuse petochal, ling an bruises on his legs Abdominal oxamiton sina for hepatorpenomegaly Urseoue ofthe abdomen conf: Hepatspienanegaly and ao stows munpe enarged mesenteric ph node A complete 00d count (CAC) shows sever anomia and thrombocycpori with lukecyoss Which of the fotiowng the most lea cagnoss nts paben?| A cite lukeria so Asactc onem x ©. mmuncogic trombocyopenke purpura 258 Result: @ concer,Explanation: ‘Comect answer A Wile various hematlogcl dst ders yrphoma. for ‘vampl) should be in ho aero, oewo leukemia sta mot Katy ‘lagosis considering the age of the pal. Chronic leukemia ery rein ‘alent thie young Dtrbances in a3 eal neages shold alway be ‘xamind turer fr eeu lukomia AVL and ALL). Inaddbon to CBC. a pepheral bleed smear arc bone marow bcpsy should 'be performs n order to ont he agnosis. Depending onthe type of Related Videos: © tasers ee Leer We eos cet Pane ses lee ls sia sacks n woe Wala _acuto loukomia, patonts should also undergo a lumbar puncture to essass for First Aid References: XSite, Texter cmon epnds ent pean sie of ag ena Option B. Taxes of te Fst Ad forthe USMLE Stop 12018, 28 oh: 420 ‘evenly unk Aso, woud play present se wth pancytopenia. Fst Afr the USMLE Step 1201727 ed 10 Option: Aplastic anemia uals chaactotzed by paneytopent. nay, te disease may pesort th dturbances in only ane or wo ol Inooges, but _leocnoss ist typi seen easbusa| ‘OptonD: ITP could be responsible for rombocytopeni, bu wou not etl tee cl Ineages TP ele eer unas ina patent 0 yong ‘Option: tronic leukemias eeremely rare atthe ago f 12 Ako, doesnt geesses lee ls sia sacks n woe Wala ee seebe eeu saa ato this young Ditrbances in a3 cal nage sould alway be ‘seminar fr ocute leukemia AML and ALL). be performed norerto ont the agnosis. Depending onthe ype of ‘acute leukemia, patierss shout aso undergo a kbar puncure to sess ok {CNSinftration. reatmentis complet and depend onthe type and sage of the cieaee, ‘Option B:Tberculos ofthe bone marow fs very ae, mak this gn ‘evenly ula Alo, t would typiealy present sa wth panytopena. ‘Option C:Apaetc anemia vel ie charactor by panetepans nay, te ciscase may poser th dstuances ion One or wo ol Inoagos, but loko ist tial see OpfonD: ITP coud be responsible for thombacyopeia, butt woud nt fect tree col Ineages. TP ie als extremely unikay na patent 0 young. ‘OptonE Cron eukeminis extremely rave atthe age f 12. Aso. doesnt ‘yplalycoure disturbances inal cell neages, especialy naa. Leaming objective: Acts love lhe most commen hematlogcl arpa al inages, resulting in» grandcoytoss or lmmphocross, ‘especialy. Cinta, ts presents a jit orbone pa atgue, welt oes, {vt and tequentefecons. A CAC and perperasmea,along wih the nal symptoms, can sugget the lognss, but a bone marrow bogs is ejector contimaton In sm orm fact even, 3 mba once ‘alco cated areas for CNS wataton First Aid References: Fst Ad forthe USMLE Step 12019, 20h ea): 424 Fst Ald fr the USMLE Sep 1 2048, 28th e420, Fst Afr the USMLE Step 1204727 ed 10