Weird sensation, Hyporeflexia, and Abnormal Urine Test! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 03-23-2012
DocSikorski's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,353
Threads: 94
Thanked 877 Times in 507 Posts
Reputation: 890
Urine Sample Weird sensation, Hyporeflexia, and Abnormal Urine Test!

Made a question myself, there might be mistakes.
__________________________________________________ _____________
A 55 year old lady, a host at the ballroom in downtown Chicago comes to you for annual evaluation. She proudly says that the events that she hosted for more than 20 years were reach in famous Midwestern steaks and expensive drinks. She appears skinny, jokes around and mentions many names of the city celebrities that she likes to have a drink or two with. She complains of feeling weird in her toes. You notice decreased Achilles tendon reflexes. After the blood analysis is done you make a diagnostic test and after the absence of radiolabeled substance in the urine you make a diagnosis. What is the reason of her condition?

a. Iron deficiency
b. Malaria
c. Hepatitis
d. CREST
e. Lupus
f. Pancreatitis
g. Goodpasture's syndrome
h. Myasthenia gravis
I. Ankylostoma
j. Beer consumption
__________________
Ambition is a dream with a V8 engine. EP
Reply With Quote Quick reply to this message
The above post was thanked by:
Dr. Mexito (03-24-2012)



  #2  
Old 03-23-2012
LatinGeorge's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 653
Threads: 47
Thanked 409 Times in 249 Posts
Reputation: 419
Default

I am sure you took some clues off the question, not much buzzwords there.
I would say h. MG
Reply With Quote Quick reply to this message
  #3  
Old 03-23-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 539 Times in 375 Posts
Reputation: 549
Default

Well its Vit B12 def ...hes talking about the schilling test , dec vibrations , absent reflex ......

but alcohol consumption causes folic acid def not Vit B12 ??

Still go with J ........ beer ........
Reply With Quote Quick reply to this message
 
  #4  
Old 03-23-2012
LatinGeorge's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 653
Threads: 47
Thanked 409 Times in 249 Posts
Reputation: 419
Default

Quote:
Originally Posted by Hitman View Post
Well its Vit B12 def ...hes talking about the schilling test , dec vibrations , absent reflex ......

but alcohol consumption causes folic acid def not Vit B12 ??

Still go with J ........ beer ........
I was thinking exactly the same thing, some malabsorption problem, maybe chronic pancreatitis with sec b12 def neuropathy, but no symptoms there.
Reply With Quote Quick reply to this message
  #5  
Old 03-23-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS+3
Posts: 170
Threads: 6
Thanked 137 Times in 90 Posts
Reputation: 147
Default

reading the stem i thought this is pernicious anemia, & i was looking for atrophic gastritis in the answers.
afaik chronic pancreatitis shouldn't cause b12 deficiency; its more related with fat soluble vitamins
Reply With Quote Quick reply to this message
  #6  
Old 03-23-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 138
Threads: 1
Thanked 46 Times in 26 Posts
Reputation: 56
Default

I. Ankylostoma
Reply With Quote Quick reply to this message
  #7  
Old 03-24-2012
DocSikorski's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,353
Threads: 94
Thanked 877 Times in 507 Posts
Reputation: 890
Default

Nah, there are enough of clues and buzz words: She eats meat, but still the Shilling test is abnormal!

Neurosensory abnormality - tingling (weird feeling) and dicreased deep tendon reflexes. - classic B12 deficiency.

1. Pernicious anemia? - could be, but not in the options...
2. Bacterial overgrowth? - probably - not in options.
3. She could easily have had some previous bowel surgery - but not in options again...
4. the last one is left - pancreatitis? - might be... + she drinks.

so the answer is F Pancreatitis.

2hitman: very interesting poin - beer does not cause folic acid deficiency - there is a lot of folic acid in beer...

2Britney - it should have been difilobotrium latum
__________________
Ambition is a dream with a V8 engine. EP
Reply With Quote Quick reply to this message
  #8  
Old 03-24-2012
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 64
Threads: 12
Thanked 34 Times in 20 Posts
Reputation: 44
Default

F = Pancreatitis

I agree with the clues for B12 deficiency

what is I say it's a Vit E deficiency.

alcoholism (Beer)--> Pancreatitis --> Pancreatic insufficiency--> deficiency in ADEK vitamines --(vit E def) causes neurodysfunction with posterior (Dorsal) colum demyelination and ...

just stimulating our minds guys to think of a possible connection here that might not work !!!!

@ DocSikorski: I'm not very sure of your response to 2hitman's choice. Can you please give us a reference to clarify that!!
Reply With Quote Quick reply to this message
  #9  
Old 03-24-2012
DocSikorski's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,353
Threads: 94
Thanked 877 Times in 507 Posts
Reputation: 890
Default

Quote:
Originally Posted by theundead View Post
reading the stem i thought this is pernicious anemia, & i was looking for atrophic gastritis in the answers.
afaik chronic pancreatitis shouldn't cause b12 deficiency; its more related with fat soluble vitamins
pancreatic enzymes cleave R-complex to make B12 available for intrinsic factor to bind in duodenum
__________________
Ambition is a dream with a V8 engine. EP
Reply With Quote Quick reply to this message
The above post was thanked by:
doctorFH (03-24-2012)
  #10  
Old 03-24-2012
DocSikorski's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,353
Threads: 94
Thanked 877 Times in 507 Posts
Reputation: 890
Default

Quote:
Originally Posted by Desos View Post
F = Pancreatitis

I agree with the clues for B12 deficiency

what is I say it's a Vit E deficiency.

alcoholism (Beer)--> Pancreatitis --> Pancreatic insufficiency--> deficiency in ADEK vitamines --(vit E def) causes neurodysfunction with posterior (Dorsal) colum demyelination and ...

just stimulating our minds guys to think of a possible connection here that might not work !!!!

@ DocSikorski: I'm not very sure of your response to 2hitman's choice. Can you please give us a reference to clarify that!!
Goljan (thats where I heard of it)

from the top of Google - http://www.chm.bris.ac.uk/webproject...epp/folic.html
__________________
Ambition is a dream with a V8 engine. EP
Reply With Quote Quick reply to this message
  #11  
Old 03-24-2012
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 64
Threads: 12
Thanked 34 Times in 20 Posts
Reputation: 44
I disagree

Quote:
Originally Posted by DocSikorski View Post
Goljan (thats where I heard of it)

from the top of Google - http://www.chm.bris.ac.uk/webproject...epp/folic.html

Please listen to Goljan again because I remember he said :

" There are 3 things that block folate absorption in the jejunum:
(1) phenytoin-- by inhibiting intestinal conjugase
(2) Birth control pills
(3) Alcohol ---(MCC of folate deficiency = Alcoholism)"

These were Dr Goljan's words. you may want to verify so that we are all clear on this concept.
Reply With Quote Quick reply to this message
  #12  
Old 03-24-2012
DocSikorski's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,353
Threads: 94
Thanked 877 Times in 507 Posts
Reputation: 890
Default

Quote:
Originally Posted by Desos View Post
Please listen to Goljan again because I remember he said :

" There are 3 things that block folate absorption in the jejunum:
(1) phenytoin-- by inhibiting intestinal conjugase
(2) Birth control pills
(3) Alcohol ---(MCC of folate deficiency = Alcoholism)"

These were Dr Goljan's words. you may want to verify so that we are all clear on this concept.
Man, you got to take a break from studying and go out
There are many other drinks that contain alcohol except for beer.
But don't get too hard on them, cuz they are stronger than beer and do not contain folate so they could make you folate deficient...
__________________
Ambition is a dream with a V8 engine. EP
Reply With Quote Quick reply to this message
The above post was thanked by:
doctorFH (03-24-2012)
  #13  
Old 03-24-2012
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 64
Threads: 12
Thanked 34 Times in 20 Posts
Reputation: 44
Default

Quote:
Originally Posted by DocSikorski View Post
Man, you got to take a break from studying and go out
There are many other drinks that contain alcohol except for beer.
But don't get too hard on them, cuz they are stronger than beer and do not contain folate so they could make you folate deficient...

hahahahahahahah

If I wish I could drink a beer but .....
Reply With Quote Quick reply to this message
The above post was thanked by:
DocSikorski (03-24-2012)



Reply

Tags
Biochemistry-, Pathology-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Staphylococcus Saprophyticus and Nitrite urine test? Drbooda USMLE Step 1 Forum 6 03-22-2012 10:41 AM
Weird Statistics jinni USMLE Step 1 Forum 4 03-02-2012 02:40 PM
Percent chance of a test being abnormal mayursn39 USMLE Step 1 Forum 9 09-28-2011 11:55 PM
Weird cases Verocita USMLE Step 3 Forum 1 09-22-2011 05:19 AM
Very weird NBME 6 score.... warriodoc USMLE Step 1 Forum 1 04-11-2011 06:56 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)