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LFT's <br>
LFT's <br>
AST 100 IU/L <br>
:* AST 100 IU/L <br>
ALT 90 IU/L <br>
:* ALT 90 IU/L <br>
Prothrombin time 20 secs
:* Prothrombin time 20 secs<br>
Bilirubin 2.0
:* Bilirubin 2.0


Urinalysis: <br>
Urinalysis: <br>
Color - pale<br>
:* Color - pale<br>
pH – 5 <br>
:* pH – 5 <br>
Specific gravity – 1.010 <br>
:* Specific gravity – 1.010 <br>
Ketones – None <br>
:* Ketones – None <br>
Nitrates – Negative <br>
:* Nitrates – Negative <br>
Leukocyte esterase – Negative <br>
:* Leukocyte esterase – Negative <br>
WBCs - ≤2-5 WBCs/hpf <br>
:* WBCs - 3 WBCs/hpf <br>
Casts – 0-5 hyaline casts/lpf <br>
:* Casts – 0-5 hyaline casts/lpf <br>
Crystals – none <br>
:* Crystals – none <br>
Uroporphyrin    Elevated <br>
:* Uroporphyrin    Elevated <br>
Porphobilinogen Normal  
:* Porphobilinogen Normal  


USG: Normal liver architecture
USG: Normal liver architecture
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The patient is diagnosed with an enzymatic defect in heme metabolism, which of the following indicates the disease and the associated enzymatic defect?
The patient is diagnosed with an enzymatic defect in heme metabolism, which of the following indicates the disease and the associated enzymatic defect?


[[Image:Heme synthesis copy.jpg|300px]
[[Image:Heme synthesis copy.jpg|300px]]
|AnswerA=Congenital erythropoietic porphyria; uroporphyrinogen III synthase
|AnswerA=Congenital erythropoietic porphyria; uroporphyrinogen III synthase
|AnswerB=Porphyria cutanea tarda; uroporphyrinogen III decarboxylase
|AnswerB=Porphyria cutanea tarda; uroporphyrinogen III decarboxylase

Revision as of 01:44, 13 January 2014

 
Author [[PageAuthor::Vidit Bhargava, M.B.B.S [1]]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Dermatology
Prompt [[Prompt::A 35 year old female presents with a 2 week history of sensitivity to sunlight. Whenever she steps outside unprotected she develops blistering, scarring, pigmentation on the back of her hands and face. She has also noticed increased hair growth at unusual places during these past 2 weeks. She is sexually active and takes oral contraceptives regularly. The physician orders the following labs:

Complete blood count:

  • Hemoglobin 12.0 mg/dL
  • Hematocrit 45%
  • RBC's 4 million/cc
  • WBC's 8000 /cc
  • Platelets 3 lac/cc

LFT's

  • AST 100 IU/L
  • ALT 90 IU/L
  • Prothrombin time 20 secs
  • Bilirubin 2.0

Urinalysis:

  • Color - pale
  • pH – 5
  • Specific gravity – 1.010
  • Ketones – None
  • Nitrates – Negative
  • Leukocyte esterase – Negative
  • WBCs - 3 WBCs/hpf
  • Casts – 0-5 hyaline casts/lpf
  • Crystals – none
  • Uroporphyrin Elevated
  • Porphobilinogen Normal

USG: Normal liver architecture

The patient is diagnosed with an enzymatic defect in heme metabolism, which of the following indicates the disease and the associated enzymatic defect?

]]

Answer A AnswerA::Congenital erythropoietic porphyria; uroporphyrinogen III synthase
Answer A Explanation AnswerAExp::
Answer B AnswerB::Porphyria cutanea tarda; uroporphyrinogen III decarboxylase
Answer B Explanation AnswerBExp::
Answer C AnswerC::Acute intermittent porphyria; porphobilinogen deaminase
Answer C Explanation AnswerCExp::
Answer D AnswerD::Variegate porphyria; protoporphyrinogen oxidase
Answer D Explanation AnswerDExp::
Answer E AnswerE::Acute porphyria; ALA dehydrogenase deficiency
Answer E Explanation AnswerEExp::
Right Answer RightAnswer::B
Explanation [[Explanation::

Educational Objective:
References: ]]

Approved Approved::No
Keyword
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