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  #1  
Old 08-24-2012
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Blood Confusing Hematology Question!

A 76 year old man is brought to the office by his son, who states that his father has been forgetful over the last few months and keeps asking the same questions again and again. The Pt. Complains of increasing generalising weakness, fatigue, and tingling sensations on the lower extremities. His appetite is unchanged and he maintains a ba;lance diet. The Pt. appears somnolent but is oriented to time place and person. HEENT : Conjunctiva midly icteric; red, smooth tongue is observed, heart : regular rate and rhythm, with an S1 and S2; a systolic ejection murumur is heard. Abdomen is mildly distended. Neurological exam : Muscle strength 4/5 throughout, loss of position and vibration sense in lower extremities, ataxic gait. Lab reports :

Hb 10
Platelets 190,000
WBC 4000

Granulocytes 60%
Lymphocytes 30 %
Monocytes 5%

MCV : 110

MCHC 35
MCH 33.6
TSH 3 (N 0.5-5)
Urine methyl malonate increased

After confirming the diagnosis of this patient's condition, which of the following should be considered in future evaluation ?

A. Calcium

B. Fasting Blood Glucose

C. Folic Acid

D. Gastrin Level

E. Plasma Homocysteine

Pls Explain ur answer
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Old 08-24-2012
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B12 deficiency....homocysteine levels are raised in this condition along with folate and B6 def too.......

but i think the diagnosis here would be pernicious anaemia( MCC of B12 def if im not wrong) so measure gastrin levels----atrophic glossitis,elderly...

answer may be D......
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Old 08-24-2012
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I too felt the same but the answer is Calcium and they have given a weird explanation that since the diagnosis is a pernicious anemia so it can be associated with many autoimmune diseases such as DM, Hashimoto thyroiditis, Gonadal failure, Vitiligo, Lambert Eaton syndrome and Primary Hypothyroidism so Ca will help in the evaluation of these autoimmune diseases. Dont know what they are trying to explain
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Quote:
Originally Posted by usmle2011 View Post
I too felt the same but the answer is Calcium and they have given a weird explanation that since the diagnosis is a pernicious anemia so it can be associated with many autoimmune diseases such as DM, Hashimoto thyroiditis, Gonadal failure, Vitiligo, Lambert Eaton syndrome and Primary Hypothyroidism so Ca will help in the evaluation of these autoimmune diseases. Dont know what they are trying to explain

weird man.......can u specify the source..??? i dont get their idea behind choosing calcium....

sometime's i feel qbanks other than uworld have mistakes in them so i always filter stuff.....
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Old 08-24-2012
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Quote:
Originally Posted by usmle2011 View Post
A 76 year old man is brought to the office by his son, who states that his father has been forgetful over the last few months and keeps asking the same questions again and again. The Pt. Complains of increasing generalising weakness, fatigue, and tingling sensations on the lower extremities. His appetite is unchanged and he maintains a ba;lance diet. The Pt. appears somnolent but is oriented to time place and person. HEENT : Conjunctiva midly icteric; red, smooth tongue is observed, heart : regular rate and rhythm, with an S1 and S2; a systolic ejection murumur is heard. Abdomen is mildly distended. Neurological exam : Muscle strength 4/5 throughout, loss of position and vibration sense in lower extremities, ataxic gait. Lab reports :

Hb 10
Platelets 190,000
WBC 4000

Granulocytes 60%
Lymphocytes 30 %
Monocytes 5%

MCV : 110

MCHC 35
MCH 33.6
TSH 3 (N 0.5-5)
Urine methyl malonate increased

After confirming the diagnosis of this patient's condition, which of the following should be considered in future evaluation ?

A. Calcium

B. Fasting Blood Glucose

C. Folic Acid

D. Gastrin Level

E. Plasma Homocysteine

Pls Explain ur answer
Well as this is weird Q & A, i 'd give a wierd explanation:
Since the case is pernicious anemia, we expect high gastrin level to increase the acid production. And as we know hypercalcemia can increase gastrin level, may be Ca level will be helpful to identify the hight gastrin wether its secondary to the anemia or Ca.
But i feel D is more appropriate as we don't have to jump over gastrin level directly & don't see any association btw Ca & autoimmune disorders.
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Old 08-25-2012
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Quote:
Originally Posted by anomali View Post

weird man.......can u specify the source..??? i dont get their idea behind choosing calcium....

sometime's i feel qbanks other than uworld have mistakes in them so i always filter stuff.....
Kaplan Qbank is the source. They have a weird qns like this in each block
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Old 08-25-2012
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Quote:
Originally Posted by Anders View Post
Well as this is weird Q & A, i 'd give a wierd explanation:
Since the case is pernicious anemia, we expect high gastrin level to increase the acid production. And as we know hypercalcemia can increase gastrin level, may be Ca level will be helpful to identify the hight gastrin wether its secondary to the anemia or Ca.
But i feel D is more appropriate as we don't have to jump over gastrin level directly & don't see any association btw Ca & autoimmune disorders.
I feel gastrin is the way to go.
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