You are asked by your secretary to consult on her father, who has been to several physicians who hav

Discussion in 'USMLE Step 2 CK' started by samuel, Dec 18, 2014.

  1. samuel

    samuel New Member

    You are asked by your secretary to consult on her father, who has been to several physicians who have not been able to discern the cause of his anemia. The father is a 67-year-old, well-nourished, talkative man who is in no apparent distress. He is not taking any medications. He has been drinking a fifth of whiskey per day for the last 20 years, and smokes 10 cigarettes per day. He has palmar erythema and spider angiomata on his upper chest area. A recent gastrointestinal workup including esophagogastroduodenoscopy, push enteroscopy of the small bowel, and colonoscopy revealed: 1+ esophageal varices; no bleeding lesions, ulcers, or gastritis in the stomach; normal small bowel; and no lesions, polyps, diverticula, or hemorrhoids in the colon. Serum protein electrophoresis and immunofixation did not reveal a monoclonal protein. Laboratory studies show: BUN 12 mg/dL, creatinine 0.8 mg/dL, hemoglobin 10.5 g/dL, MCV 75, serum iron 226 microgram/dL, TIBC 330 microgram/dL, transferrin saturation 75%. Cytogenetics show normal male 46,XY. Hemoglobin electrophoresis shows HbA 97%, HbA2 2%, and HbF 1%. You decide to perform a bone marrow biopsy, which is shown.



    Which of the following is the most likely underlying cause of this patient’s anemia?

    A. Hemoglobinopathy
    B. Myelodysplastic syndrome
    C. Iron deficiency
    D. Erythropoietin deficiency
    E. Chronic alcoholism

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