Anemia q - 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 05-13-2014
USMLE Forums Scout
 
Steps History: Not yet
Posts: 25
Threads: 10
Thanked 8 Times in 8 Posts
Reputation: 18
Default Anemia q

A 15-year-old girl who is a ballet dancer has not
had a menstrual period for the past 3 months.
Menses were previously regular at 29-day
intervals. She has lost weight over the past year;
her weight is 70% of that expected for her
height. She is afebrile and has purpuric lesions
on her extremities and trunk. Platelet, absolute
neutrophil, and lymphocyte counts are below the
reference range. She has macrocytic anemia. The
most likely cause of these symptoms is a
deficiency of which of the following nutrients?
(A) Folic acid
(B) Iron
(C) Linoleic acid
(D) Magnesium
(E) Niacin
(F) Protein
(G) Vitamin A
(H) Vitamin B6 (pyridoxine)
(I) Vitamin C
(J) Vitamin D
(K) Vitamin E
(L) Vitamin K
(M) Zinc

I chose vitamin C which is wrong. I was distracted by the purpuric lesion which seems to be caused by vessel wall weakness due to VC deficiency induced collagen synthesis defect.
My question is the only clue to answer (A folic def) this question is macrocytic anemia? Thanks~
Reply With Quote Quick reply to this message



  #2  
Old 05-13-2014
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 214
Threads: 12
Thanked 107 Times in 68 Posts
Reputation: 117
Default

could it be folic acid def. emerged upon anorexia? In any case i would chose A. Because others dont make sense
Reply With Quote Quick reply to this message
  #3  
Old 05-13-2014
USMLE Forums Scout
 
Steps History: Not yet
Posts: 25
Threads: 10
Thanked 8 Times in 8 Posts
Reputation: 18
Default

Quote:
Originally Posted by Barıs Olten View Post
could it be folic acid def. emerged upon anorexia? In any case i would chose A. Because others dont make sense
You are right. Folic def is the right answer. But I don't know how can folic deficiency cause purpuric lesions?
Reply With Quote Quick reply to this message
  #4  
Old 05-13-2014
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 214
Threads: 12
Thanked 107 Times in 68 Posts
Reputation: 117
Default

Quote:
Originally Posted by usmle778 View Post
You are right. Folic def is the right answer. But I don't know how can folic deficiency cause purpuric lesions?
Well in Folic acid def. you have slightly decreased neutrophil and platelet counts. Decreased plt. counts can contribute to purpura
Reply With Quote Quick reply to this message
The above post was thanked by:
usmle778 (05-13-2014)
  #5  
Old 05-13-2014
USMLE Forums Addict
 
Steps History: CS Only
Posts: 100
Threads: 1
Thanked 47 Times in 35 Posts
Reputation: 57
Send a message via Skype™ to coliris
Default

OP you have to look at the big picture, there are a lot more clues in the vignette to point to low iron or folic acid intake than to Vit C deficiency. They are giving you a teenager girl, ballet dancer (VERY often used in questions so you automatically think about anorexia or poor eating), no menses, excessive weight lose, macrocytic anemia... yes you could think bit C only for that, but what about the other clues? take into account that very often they add things in the question to throw us out of play, and make us choose a different answer.
__________________
If you are on Google plus (G+) join this growing USMLE community -->
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
The above post was thanked by:
usmle778 (05-14-2014)
  #6  
Old 05-13-2014
USMLE Forums Addict
 
Steps History: Step 1 Only
Posts: 136
Threads: 28
Thanked 18 Times in 14 Posts
Reputation: 28
Default

1.) mcc of macrocytic anemia in usa is folic acid def..

2.) question says ballet dancer hence eats really less ( most commonly suffers from anorexia nervosa or vitamin def...)

3.) vit C hardly presents without the patient having bleeding gums and a slight decrease in immunity..

i hope this helps..
Reply With Quote Quick reply to this message
The above post was thanked by:
ANUBHAV (05-14-2014), usmle778 (05-14-2014)
  #7  
Old 05-13-2014
USMLE Forums Scout
 
Steps History: Not yet
Posts: 31
Threads: 1
Thanked 7 Times in 7 Posts
Reputation: 17
Default

Clue here is PANCYTOPENIA with megaloblastic anemia--> Folic or B12 deficiency.
Since there are no neurologic symptoms and B12 not given in option, only folic acid fits best in.
Reply With Quote Quick reply to this message
The above post was thanked by:
usmle778 (05-14-2014)



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
Changes in anemia tai35 USMLE Step 1 Forum 0 08-21-2013 09:51 PM
about anemia minamina USMLE Step 1 Forum 1 09-26-2012 09:02 PM
Which anemia is this? tyagee USMLE Step 2 CK Forum 2 07-29-2012 08:44 PM
Anemia of Chronic Disease : Micro or Normocytic anemia? lemontea88 USMLE Step 1 Forum 8 09-27-2011 05:20 PM
What is the cause of anemia? RRMadukha USMLE Step 2 CK Forum 8 04-20-2010 02:22 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)