Question of the Week # 434

434) A 44 year old woman is evaluated in your office for one month history of worsening fatigue. She also reports tingling and numbness in bilateral lower extremities. Her past medical history is significant for morbid obesity for which she underwent gastric bypass surgery four years ago. She has lost about 80lbs weight since her surgery. Her medications include oral ferrous sulfate, folic acid and vitamin b-complex. Physical examination reveals absent ankle jerks. Laboratory Studies reveal WBC 5400/µl HGB: 9.8 gm%, MCV 74 fl, Platelets : 300k/µl, Serum ferritin 280ng/ml, Transferrin saturation 26% . A bone marrow aspirate smear is shown below :

Archer USMLE

Which of the following is the most likely cause of patient’s presentation?

A) Iron deficiency

B) Copper deficiency

C) Vitamin B12 deficiency

D) Zinc deficiency

E) Pure red cell aplasia

Archer USMLE Step 2 CLINICAL SKILLS

Why subscribe to Archer Step 2CS Review?

1. Archer believes in offering the best possible online education so that your expenses can be minimized and efficiency is maximized. By providing these online video encounters, more information and more number of cases can be communicated to you when compared to the limited number of cases that can be practiced in a two day or three day . The Existing live Step 2CS courses that provide limited encounters are highly priced at $1000 for providing lesser information. Archer step 2CS videos provide 47 Clinical Cases and highly helpful strategies to easily pass your Step 2CS exam for a nominal price of less than $50. You can watch these encounters number of times until you understand and master the skills.

2. Archer is the most successful and trusted Step 3 Review course in the market with thousands of USMLE subscribers. Our Facebook page boasts a rapidly growing fan base of 114,500 students and medical graduates. It provides a huge social network base for USMLE preparing students so you can learn and master concepts while you interact. Hundreds of students have requested us to expand our services to cover USMLE step 2CS and step 2CK. At Archer, we care about you and assist you with every step during your preparation process. We understand your financial constraints as well hence,we have kept the prices at the lowest levels. These are extremely affordable and does not require you to spend thousands of dollars unlike the other live review courses in the market.

Video Encounters: The Following is the list of Highyield Step 2CS cases you will master from Archer Step 2CS course. Along with these encounters, you will also master Patient Note, Communication skills, Helpful strategies, English speaking skill and Physical examination skills. We

Encounter Key:
Disease  Encounter
Afib  Encounter: 1
Anemia  Encounter: 2
Angina  Encounter: 3
Aortic Dissection  Encounter: 4
Benign Positional Vertigo  Encounter: 5
Bronchitis  Encounter: 6
Chest Wall Strain  Encounter: 7
CHF  Encounter: 8
COPD  Encounter: 9
Depression  Encounter: 10
Diverticulosis  Encounter: 11
DVT  Encounter: 12
Esophageal Spasm  Encounter: 13
Food Poisoning  Encounter: 14
Gastroenteritis  Encounter: 15
General Tendenitus  Encounter: 16
Gout  Encounter: 17
Heptocellular Carcinoma  Encounter: 18
Hyperglycemia  Encounter: 19
Hyperthyroidism  Encounter: 20
Hypoglycemia  Encounter: 21
Hypothyroidism  Encounter: 22
Irritable Bowel  Encounter: 23
Medication Side Effect  Encounter: 24
Migrane  Encounter: 25
Nephrolithiasis Appendicitis  Encounter: 26
Obstruvtibe Sleep Apnea  Encounter: 27
Orthostatic Hypotension  Encounter: 28
Osteoarthritis  Encounter: 29
Otitis Externia  Encounter: 30
Ovarian Cyst  Encounter: 31
Pancreatitis  Encounter: 32
Peptic Ulcer  Encounter: 33
Pericarditis  Encounter: 34
Pharyngitis  Encounter: 35
Pneumocystis Carini  Encounter: 36
Pulmonary Embolism  Encounter: 37
Rheumatoid Arthritis  Encounter: 38
Septic Arthritis  Encounter: 39
Shingles  Encounter: 40
Sinusitis  Encounter: 41
Subdural Hematoma  Encounter: 42
Syncope  Encounter: 43
Temporal Arteritis  Encounter: 44
TIA  Encounter: 45
Ulcerative Colitis  Encounter: 46
Urinary Tract Infection  Encounter: 47
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