Hematologic Hepatosplenomegaly! - 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 04-29-2010
USMLE Forums Scout
 
Steps History: Not yet
Posts: 97
Threads: 52
Thanked 135 Times in 49 Posts
Reputation: 135
Blood Hematologic Hepatosplenomegaly!

A 56-year-old man presents to his physician complaining of severe fatigue. He began to feel increasingly tired about 6 months ago, but believes that his fatigue has been worsening over the past 3 weeks. He also notes that he has had a nonproductive cough for about 2 weeks, and has experienced several episodes of drenching night sweats. On examination, he has several large bruises on his extremities but recalls no injuries. Abdominal examination reveals massive enlargement of both the liver and the spleen, without any lymphadenopathy.

Laboratory tests show:
WBC count 12,000/mm3
Neutrophils 58%
Eosinophils 7%
Lymphocytes 30%
Monocytes 0%
Basophils 5%
RBC count 3.0/mm3
Hemoglobin 7.5 mg/dL
Platelet count 18,000/mm3
Peripheral blood smear reveals irregular nuclei and cell membranes, as well as cytoplasmic projections.

What is the patient’s most likely diagnosis?
(A) Acute lymphocytic leukemia
(B) Hairy cell leukemia
(C) Idiopathic thrombocytopenic purpura
(D) Infectious mononucleosis
(E) Nodular sclerosing Hodgkin’s lymphoma
Reply With Quote Quick reply to this message
The above post was thanked by:
rigbbm (09-05-2013)



  #2  
Old 04-29-2010
ath.pantelis's Avatar
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 187
Threads: 4
Thanked 368 Times in 121 Posts
Reputation: 398
Default

"Cytoplasmic projections" --> hairy cell leukemia, for USMLE purposes, without second thought.

Hairy cell leukemia (CLL in general -- hairy cell leukemia is a special type of CLL) is one of the two most notorious entities for causing massive hepatosplenomegaly (the other one is leishmaniasis, which causes only splenomegaly; storage disease etc are other causes, but this is not my point here... my point is to have leishmaniasis in mind in a middle-aged pt with a very large spleen).

Constitutional symptoms (fever, malaise, night sweats -- in the case of Hodgkin's diesease they are called beta symptomatology) are common. The bruises found in this patient is apparently due to low platelet count, which in turn is due to infiltration of the bone marrow by the leukemic cell line. Low RBC count comes to support this statement.

Nodular sclerosis HD is found primarily in young adults; ALL is found almost exclusively in children (acute exacerbation in CLL patients is called blast crisis, but this entity is far more common in CML). Infectious mononucleosis is not common in a pt 56yo and, although it could cause inversion of the WBC type, it doesn't affect RBCs and PLTs. ITP would affect only the PLT cell line and in this case the spleen is usualy NOT enlarged, although PLT destruction occurs in this organ (bear in mind that ITP may sometimes be a manifestation of a hematologic malignancy, though).
Reply With Quote Quick reply to this message
The above post was thanked by:
excellence (04-20-2014), mosallam (04-29-2010), nano (05-02-2010), RRMadukha (04-29-2010), Sabio (04-29-2010), speedballz_21 (04-29-2010)
  #3  
Old 04-29-2010
ath.pantelis's Avatar
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 187
Threads: 4
Thanked 368 Times in 121 Posts
Reputation: 398
Default

In my previous post I forgot to mention the association of hairy cell leukemia with the expression of Tartrate-resistant acid phosphatase (TRAP).

In order to remember this correlation, I have made an imaginary face in my mind: a guy with messy hair (let's say Einstein)... his HAIR is a TRAP for particles & stuff.
Reply With Quote Quick reply to this message
The above post was thanked by:
nano (05-02-2010), rigbbm (09-05-2013)



Reply

Tags
Hematology-, 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


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)