A 60-year-old man has developed widespread... - 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 06-18-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 557 Times in 318 Posts
Reputation: 567
Default A 60-year-old man has developed widespread...

A 60-year-old man has developed widespread ecchymoses over the skin in the past month. His medical history includes a diagnosis of mucinous adenocarcinoma of the rectum. On physical examination, he appears cachectic and pale. An abdominal CT scan shows multiple hepatic masses. Laboratory studies show prothrombin time of 30 sec, partial prothrombin time of 55 sec, PLT 15,200/mm3, fibrinogen level 75mg/dl, and fibrin split product level (D-dimer) that are very elevated. Which of the following morphologic findings is most likely to be present on examination of his peripheral blood smear?

A) Howell-Jolly bodies
B) Teardrop cells
C) Macro-ovalocytes
D) Schistocytes
E) Target cells

Please try to explain your answer
Reply With Quote Quick reply to this message



  #2  
Old 06-18-2012
Hope2Pass's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,684
Threads: 213
Thanked 1,590 Times in 660 Posts
Reputation: 1600
Default

D) Schistocytes

This presentation is classic for DIC.
It forms micro thrombi.
As the RBC's pass through the micro thrombi they get "sliced" or "cut" by the micro thrombi.
This is what schistocytes look like:



*I hope that's the correct answer. Your questions are tricky sometimes lol*
Reply With Quote Quick reply to this message
The above post was thanked by:
..sharma (06-20-2012), Casandra (06-18-2012)
  #3  
Old 06-18-2012
imgchuchu's Avatar
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 218
Threads: 4
Thanked 74 Times in 55 Posts
Reputation: 84
Default

Quote:
Originally Posted by Casandra View Post
A 60-year-old man has developed widespread ecchymoses over the skin in the past month. His medical history includes a diagnosis of mucinous adenocarcinoma of the rectum. On physical examination, he appears cachectic and pale. An abdominal CT scan shows multiple hepatic masses. Laboratory studies show prothrombin time of 30 sec, partial prothrombin time of 55 sec, PLT 15,200/mm3, fibrinogen level 75mg/dl, and fibrin split product level (D-dimer) that are very elevated. Which of the following morphologic findings is most likely to be present on examination of his peripheral blood smear?

A) Howell-Jolly bodies
B) Teardrop cells
C) Macro-ovalocytes
D) Schistocytes
E) Target cells

Please try to explain your answer


Dd..Schistocytes
Reply With Quote Quick reply to this message
  #4  
Old 06-18-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 194
Threads: 21
Thanked 145 Times in 84 Posts
Reputation: 155
Default

D) i agree

in the second i saw the first 2 lines i knew the answer, bleeding signs on the arms due to low pletlate and the carcinoma were enough,
Mucin activates the coagulation system, most of the GI cancers - pancreas ovarian, colorectal, gastric secrete mucin.
activation of the coagulation system all over the body will cause intravascular coagulation, which will consume platelets in those areas aswell as coagulation factors. this will lead to bleeding development in other areas. Classic for DIC. helmet cell a the typical presentation. the fibrin deposition inside the vessels cuts the poor red blood cells which are rushed into them at the speed of 100km/h , deadpanning where ah.
Reply With Quote Quick reply to this message
The above post was thanked by:
Casandra (06-18-2012)
  #5  
Old 06-18-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 557 Times in 318 Posts
Reputation: 567
Default :)

Guys I love your explanations!
Reply With Quote Quick reply to this message
  #6  
Old 06-18-2012
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 452
Threads: 11
Thanked 354 Times in 197 Posts
Reputation: 364
Default

D dimer=fibrin split products=schistocytes
Reply With Quote Quick reply to this message
  #7  
Old 06-19-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 557 Times in 318 Posts
Reputation: 567
Default correct answer :)

yup, correct answer is D) Schistocytes
Reply With Quote Quick reply to this message
The above post was thanked by:
DefeatTheBeast (06-20-2012)



Reply

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
Prelim this year and categorical next year Dyke IMG Residency Match Forum 1 11-18-2011 10:05 PM
68-year-old man with BPH Seetal USMLE Step 2 CK Forum 9 03-20-2011 03:54 AM
Should I apply this year or next year is OK! Rishi IMG Residency Match Forum 3 07-19-2010 10:52 AM
29 year old G2 ..... achistikbenny USMLE Step 1 Forum 6 05-25-2010 02:11 PM
16-year-old boy Seetal USMLE Step 1 Forum 3 04-12-2010 08:44 AM

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)