#july2020mccqe1
An 18-year-old man comes to clinic for evaluation of weakness and fatigue lasting 6 weeks. Before these past 6 weeks, he reports being fairly healthy. He did, however, have a recent case of “the flu.” On reviewing his medical records, it seems that approximately 2 months ago the patient had a mild hepatitis of unclear etiology (serologies for hepatitis A, B, and C were negative) that has since resolved. Before this illness, he has been healthy, takes no medications, and knows of no diseases that run in his family. He does not use illicit substances, does not smoke, rarely drinks alcohol, has never received a blood transfusion, has never had sex, and does not have any tattoos. Physical examination reveals marked pallor and a 2/6 nonradiating systolic murmur heard best at the right upper sternal border. Abdominal examination reveals a few scattered petechiae but no hepato-splenomegaly. Laboratory studies show:
Hematologic
Hematocrit 15%
Hemoglobin 5.0 g/dL
Leukocytes 4,000/mm3 (normal differential)
Platelets 15,500/mm3
Reticulocytes 0.5%
The rest of the patient’s laboratory studies, including a set of chemistries and liver function tests, are unremarkable. The patient is admitted to the hospital and receives a transfusion with leukocyte reduced blood products. A bone marrow biopsy is performed the next morning that shows cellularity of less than 5% with normal cellular morphology and no organisms on Gram stain. Which of the following is the most appropriate treatment?
(A) Antithymocyte globulin
(B) Bone marrow transplant
(C) Broad-spectrum antibiotics
(D) Colony-stimulating factor
(E) Intravenous corticosteroids
An 18-year-old man comes to clinic for evaluation of weakness and fatigue lasting 6 weeks. Before these past 6 weeks, he reports being fairly healthy. He did, however, have a recent case of “the flu.” On reviewing his medical records, it seems that approximately 2 months ago the patient had a mild hepatitis of unclear etiology (serologies for hepatitis A, B, and C were negative) that has since resolved. Before this illness, he has been healthy, takes no medications, and knows of no diseases that run in his family. He does not use illicit substances, does not smoke, rarely drinks alcohol, has never received a blood transfusion, has never had sex, and does not have any tattoos. Physical examination reveals marked pallor and a 2/6 nonradiating systolic murmur heard best at the right upper sternal border. Abdominal examination reveals a few scattered petechiae but no hepato-splenomegaly. Laboratory studies show:
Hematologic
Hematocrit 15%
Hemoglobin 5.0 g/dL
Leukocytes 4,000/mm3 (normal differential)
Platelets 15,500/mm3
Reticulocytes 0.5%
The rest of the patient’s laboratory studies, including a set of chemistries and liver function tests, are unremarkable. The patient is admitted to the hospital and receives a transfusion with leukocyte reduced blood products. A bone marrow biopsy is performed the next morning that shows cellularity of less than 5% with normal cellular morphology and no organisms on Gram stain. Which of the following is the most appropriate treatment?
(A) Antithymocyte globulin
(B) Bone marrow transplant
(C) Broad-spectrum antibiotics
(D) Colony-stimulating factor
(E) Intravenous corticosteroids
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