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  #1  
Old 09-03-2014
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Default Question for u

A 5 year old boy presents to the emergency dept with painful, swollen joints for 4 days. During PE mother mentions that his diapers often contain orange granules and he has a "bad habit" of bitting his fingers and lips.
Which of the following most likely seen on the smear of this child?

A) acanthocytes
B) elliptocytes
C) hypersegmentel neutrophils
D) ringed sideroblast
E) schicotyes
F) target cells
G) teardrop cells
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I would go with the hyper segmented neutrophils
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Old 09-03-2014
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Microscope

It is Lesch-Nyhan syndrome, for sure

and peripheral blood smear usually reveals macro-ovalocytes and hypersegmented neutrophiles (C)

and similar to orotic aciduria (pyrimidine metabolism defect) there is Megaloblastic anemia, which doesn't improve with administration of VitB12 or Folic acid
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Hypersegmented neutrophils
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Yes u all are right. Good job
In lesch nehan due to def of HGPRT pt will unable to utilize vtiB12 which causes macrocytosis and on histo it shows hypersegmented neutrophils
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Default What about this one??

A 65-year-old African-American man presents with increasing difficulty swallowing over the past 3 months. Upper gastrointestinal endoscopy reveals an annular mass with ulceration in the lower third of his esophageal wall, Histologic examination reveals increased mitosis, dysplasia, and nuclear atypia of glandular columnar epithelial cells.
Which of the following is a risk factor for this variant of esophageal cancer?

A. Achalasia
B.African-American descent
C.Consumption of hot liquids
D.Excessive alcohol use
E.Obesity
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Quote:
Originally Posted by nsesereso View Post
A 65-year-old African-American man presents with increasing difficulty swallowing over the past 3 months. Upper gastrointestinal endoscopy reveals an annular mass with ulceration in the lower third of his esophageal wall, Histologic examination reveals increased mitosis, dysplasia, and nuclear atypia of glandular columnar epithelial cells.
Which of the following is a risk factor for this variant of esophageal cancer?

A. Achalasia
B.African-American descent
C.Consumption of hot liquids
D.Excessive alcohol use
E.Obesity
I'd choose E
This is Adenocarcinoma of esophagus and GERD is strongly linked to this type of cancer, inducing Barrett metaplasia (replacement of the normal stratified squamous epithelium by simple columnar epithelium with goblet cells) which is precancerous condition.
Obese people are more likely to have esophageal reflux..
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Default A achalasia is always ass with esophageal CA (note the 3 months

Quote:
Originally Posted by nsesereso View Post
A 65-year-old African-American man presents with increasing difficulty swallowing over the past 3 months. Upper gastrointestinal endoscopy reveals an annular mass with ulceration in the lower third of his esophageal wall, Histologic examination reveals increased mitosis, dysplasia, and nuclear atypia of glandular columnar epithelial cells.
Which of the following is a risk factor for this variant of esophageal cancer?

A. Achalasia
B.African-American descent
C.Consumption of hot liquids
D.Excessive alcohol use
E.Obesity
A achalasia is always ass with esophageal CA (note the 3 months)
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More answers guys!
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Old 09-03-2014
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i would choose
E. obesity!
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I think its obesity. And linked with adenoca plus all others are the risk factors for sq.CA.
I think the presentation was of barret esophagus which causes adenoCa
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Old 09-04-2014
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Yea it's obesity! With the explanation above! All others give sq ca.

Guys I just found out the trick. Any irritant from gastric area gives adenoca and oral irritant gives sq ca.
Obesity predispose to GERD.....
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