Homeless Man with anemia and back pain - 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 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 03-03-2010
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 31
Threads: 23
Thanked 80 Times in 22 Posts
Reputation: 90
Question Homeless Man with anemia and back pain

A 56 year old homeless man came to the emergency department requesting narcotics to relieve the severe pain that he's experiencing in his lower back. He stated that the pain has been there for 15 years. Examination showed a wasted unkempt man with smell of Alcohol. Chest, cardiac, back, and neurological examinations are within normal limits. Abdominal palpation revealed enlarged liver and tender right upper quadrant.

Labs:
Hb 11 g/dL
MCV 112
Na 140 mEq/L, K 4 mEq/L, Cl 108 mEq/L,
BUN 6 mg/dL, Creatinine 0.9 mg/dL
AST 58 U/L (normal 7-27), ALT 20 U/L (normal 1-21)
Bilirubin 1.2 mg/dL (normal 0.1-1) Albumin 3.1 mg/dL (normal 3.5-5)

Which of the following is true regarding this patient presentation?
A- The liver enzyme pattern indicate a probable viral hepatitis
B- Folate deficiency is the likely cause of his anemia
C- B12 deficiency is the likely cause of his anemia
D- His back pain is likely to be due to metastatic cancer
E- He should be given narcotics for his back pain
Reply With Quote Quick reply to this message
The above post was thanked by:
Siavash71 (06-06-2013)



  #2  
Old 03-03-2010
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 247
Threads: 61
Thanked 275 Times in 105 Posts
Reputation: 305
Default

I think its B . cause
1. pt with chronic alcoholism develop folate deficiency ... causes macrocytic anemia with high MCV ....
2. Chronic alcoholism decrease bone growth and bone mass ... cause weak bone and easily fractures .....
3. Alcohol usually increase AST more than ALT ...
Reply With Quote Quick reply to this message
  #3  
Old 03-03-2010
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 31
Threads: 23
Thanked 80 Times in 22 Posts
Reputation: 90
Default

Quote:
Originally Posted by FSUSTC View Post
I think its B . cause
1. pt with chronic alcoholism develop folate deficiency ... causes macrocytic anemia with high MCV ....
2. Chronic alcoholism decrease bone growth and bone mass ... cause weak bone and easily fractures .....
3. Alcohol usually increase AST more than ALT ...
But why not B12 deficiency !
Reply With Quote Quick reply to this message
 
  #4  
Old 03-03-2010
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 247
Threads: 61
Thanked 275 Times in 105 Posts
Reputation: 305
Default

Cause in ques , neurologic examination is normal...
Most commonly patient with B12 deficiency develop peripheral neuropathy ...
Reply With Quote Quick reply to this message
The above post was thanked by:
Jayant (03-03-2010), MLE-Love (03-03-2010)
  #5  
Old 03-03-2010
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 20
Threads: 3
Thanked 4 Times in 3 Posts
Reputation: 14
Default

Quote:
Originally Posted by FSUSTC View Post
Cause in ques , neurologic examination is normal...
Most commonly patient with B12 deficiency develop peripheral neuropathy ...
You are absolutely right
Reply With Quote Quick reply to this message
The above post was thanked by:
Siavash71 (06-06-2013)



Reply

Tags
Gastroenterology-, Hematology-, Internal-Medicine-, Step-2-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
Back Pain and Hematuria! tyagee USMLE Step 2 CK Forum 11 04-15-2012 11:20 AM
back pain! salz USMLE Step 1 Forum 2 08-05-2011 02:50 AM
old man with back pain. dr_lizard USMLE Step 1 Forum 7 08-04-2011 06:36 PM
Anemia in a homeless, alcoholic, schizophrenic ecgram USMLE Step 1 Forum 6 06-04-2010 08:43 PM
Old man with lower back pain rasheed USMLE Step 1 Classic Clues 0 08-21-2009 10:25 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)