Hematology Step 3 Question - 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 3 Forum

USMLE Step 3 Forum USMLE Step 3 Discussion Forum: Let's talk about anything related to USMLE Step 3 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 09-04-2013
namita's Avatar
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 41
Threads: 10
Thanked 8 Times in 6 Posts
Reputation: 18
Blood Hematology Step 3 Question

A 25 year old woman is seen by you today due to an abnormal blood count. Three weeks ago, she volunteered for blood donation and a complete blood count that was drawn at that time showed abnormal values. She has regular menstrual periods with normal flow. Her last menstrual period was one week ago. Her previous blood count was done several years ago and she is unaware of being told they were abnormal. A complete blood count is as follows :
WBC 550/Ál
HGB: 12.1 gm%
MCV 84 fl
Platelets: 800k/Ál ( Normal 140k to 340k/ul)
Differential count : Neutrophils : 64% Lymphocytes 30% Monocytes 4%
Which of the following is the most important next step?
A) Obtain Bone Marrow Biopsy
B) Order Transferrin Saturation
C) Obtain Jak-2 Mutation Analysis
D) Obtain Arterial Blood Gases
E) Start her on Aspirin
Reply With Quote Quick reply to this message



  #2  
Old 09-04-2013
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 213
Threads: 54
Thanked 53 Times in 41 Posts
Reputation: 63
Default

Hai..since ure doing qbank..can i know which is harder n why? Step 2ck or 3? :-)
Reply With Quote Quick reply to this message
  #3  
Old 09-05-2013
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 161
Threads: 10
Thanked 76 Times in 55 Posts
Reputation: 89
Default

This is a relative new approach to thrombocytosis, but I would go for letter C:

c)
jak2 mutation (JAK2V617F) is the most important test here, because this has been implicated in myeloproliferative disorders as Essential Thrombocithemia.
it's a prove of malignant clonal hematopoiesis.

A- a bone marrow biopsy is important because even with a negative mutation (jak2 mutation is positive in 50% to 60% of cases) you can stil have essential thrombocithemia.
B- saturation of iron is very important also due to the fact that people with iron deficiency anemia may have reactive thrombocytosis.

D - arterial blood gas would be good if you had polycythemia
and E you don't start AAS even if it is essential polycythemia if the patient is young and asymptomatic


there is a very good review here:
http://asheducationbook.hematologyli...012/1/561.long
Reply With Quote Quick reply to this message
  #4  
Old 09-05-2013
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 515
Threads: 88
Thanked 505 Times in 231 Posts
Reputation: 515
Default

I would go With A.
Reply With Quote Quick reply to this message
  #5  
Old 09-05-2013
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,316 Times in 706 Posts
Reputation: 1331
Default

C perform Jak 2 mutation testing

Essential thrombocytosis becomes dangerous with counts greater than 1 million , our patient has 800 k

You never start with biopsy for anything in medicine
Reply With Quote Quick reply to this message
  #6  
Old 09-05-2013
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 515
Threads: 88
Thanked 505 Times in 231 Posts
Reputation: 515
Default

The reason I started with the biopsy is the fact that WBC is low.
Reply With Quote Quick reply to this message
  #7  
Old 09-05-2013
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,316 Times in 706 Posts
Reputation: 1331
Default

Quote:
Originally Posted by ag2011n View Post
The reason I started with the biopsy is the fact that WBC is low.

Thats a good reasoning, however asymptomatic leukopenia is not handled like that.

This patient obviously has an infiltrative process, but you dont start with biopsy.. It doesnt matter how low or high the blood cells are.. Even in frank leukemic patients you start with blood smear.

In this case I would start with the less invasive test and then follow with bone marrow biopsy.
Reply With Quote Quick reply to this message
  #8  
Old 09-05-2013
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 161
Threads: 10
Thanked 76 Times in 55 Posts
Reputation: 89
Default

probably it is a typo.
if its not, then I would go for a biopsy thinking about leukemia.
but I think he forgot one "
0"
Reply With Quote Quick reply to this message
  #9  
Old 09-05-2013
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 538 Times in 375 Posts
Reputation: 548
Default

Quote:
Originally Posted by XpaezX View Post
Thats a good reasoning, however asymptomatic leukopenia is not handled like that.

This patient obviously has an infiltrative process, but you dont start with biopsy.. It doesnt matter how low or high the blood cells are.. Even in frank leukemic patients you start with blood smear.

In this case I would start with the less invasive test and then follow with bone marrow biopsy.
true but how would JAK2 help in diagnosis , in fact i guess i read some where that JAK 2 is of no use and should not be ordered as its positive in many conditions and has no prognostic or diagnostic value . i believe that smear would be a right choice to start but since its no there to select JAK2 just because it non invasive wont seem right i guess but would be perfect for CCS

I would go with A let see , may be your right .........
Reply With Quote Quick reply to this message
  #10  
Old 09-05-2013
namita's Avatar
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 41
Threads: 10
Thanked 8 Times in 6 Posts
Reputation: 18
Default

Quote:
Originally Posted by bigBOSSguy View Post
Hai..since ure doing qbank..can i know which is harder n why? Step 2ck or 3? :-)
I think both are very same. If u give step 3 just after step 2ck, you won't have to do much reading. Just enjoy reading, everything becomes fun and easy when you enjoy
Only in step 3, CCS is an addition, and it's actually pretty interesting. ck is more of diagnosis based and step 3 is more of treatment based.

Anything is possible when you believe.
Reply With Quote Quick reply to this message
  #11  
Old 09-05-2013
namita's Avatar
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 41
Threads: 10
Thanked 8 Times in 6 Posts
Reputation: 18
Default

So I was thinking of JAK 2 mutation. Yes it's not very specific, but in this question and according to the history and labs presented it felt sufficient.
Aspirin is used for erythromelalgia in essential thrombocythemia.
I was confused bw C and E.

Any more ideas on that?
Reply With Quote Quick reply to this message
  #12  
Old 09-06-2013
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 538 Times in 375 Posts
Reputation: 548
Default

Quote:
Originally Posted by namita View Post
So I was thinking of JAK 2 mutation. Yes it's not very specific, but in this question and according to the history and labs presented it felt sufficient.
Aspirin is used for erythromelalgia in essential thrombocythemia.
I was confused bw C and E.

Any more ideas on that?
so whats the answer ??
Reply With Quote Quick reply to this message
  #13  
Old 09-06-2013
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 515
Threads: 88
Thanked 505 Times in 231 Posts
Reputation: 515
Default

Quote:
Originally Posted by Corinthiano View Post
probably it is a typo.
if its not, then I would go for a biopsy thinking about leukemia.
but I think he forgot one "
0"
I think there is problem with the construction of the question, he mentioned that the patient presented because of "an abnormal blood count", after blood donation. That means at least some sort of non invasive blood analysis has been done & if WBC is 550/Ál & Platelets: 800k/Ál ( Normal 140k to 340k/ul), and if all that is correct and no typo, then I would not waste type doing non specific testing while there is an opion of really very specific test no matter how invasive is.

Reply With Quote Quick reply to this message
  #14  
Old 09-07-2013
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 1
Threads: 0
Thanked 0 Times in 0 Posts
Reputation: 10
Default

Quote:
Originally Posted by namita View Post
A 25 year old woman is seen by you today due to an abnormal blood count. Three weeks ago, she volunteered for blood donation and a complete blood count that was drawn at that time showed abnormal values. She has regular menstrual periods with normal flow. Her last menstrual period was one week ago. Her previous blood count was done several years ago and she is unaware of being told they were abnormal. A complete blood count is as follows :
WBC 550/Ál
HGB: 12.1 gm%
MCV 84 fl
Platelets: 800k/Ál ( Normal 140k to 340k/ul)
Differential count : Neutrophils : 64% Lymphocytes 30% Monocytes 4%
Which of the following is the most important next step?
A) Obtain Bone Marrow Biopsy
B) Order Transferrin Saturation
C) Obtain Jak-2 Mutation Analysis
D) Obtain Arterial Blood Gases
E) Start her on Aspirin
i think A.
Reply With Quote Quick reply to this message



Reply

Tags
Hematology-, Internal-Medicine-, Step-3-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
Hematology question mbbs2010 USMLE Step 3 Forum 6 05-03-2013 09:02 AM
Confusing Hematology Question! usmle2011 USMLE Step 2 CK Forum 6 08-25-2012 12:04 AM
Hematology Peds Question aksyonez USMLE Step 2 CK Forum 6 07-07-2011 06:05 PM
Hematology question mayursn39 USMLE Step 1 Forum 7 06-17-2011 01:02 AM
Leukemia - Hematology Question aktorque USMLE Step 1 Forum 8 03-05-2011 01:32 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)